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Narcissistic Personality Disorder Clinical Features

Uploaded 8/13/2010, approx. 4 minute read

My name is Sam Vaknin. I am the author of Malignant Self-Love, Narcissism Revisited.

Opinions vary as to whether the narcissistic traits evident in infancy, childhood, and early adolescence are or should be considered pathological.

Anecdotal evidence suggests that childhood abuse and trauma inflicted by parents, authority figures, or even peers do provoke a kind of secondary narcissism, and when they are unresolved, may lead to the full-fledged narcissistic personality disorder later in life.

This makes eminent sense, as narcissism is a defense mechanism whose role is to deflect hurt and trauma from the victim's true self into the victim's false self. The false self is omnipotent, invulnerable, omniscient. It can therefore tolerate pain. The true self is exactly the opposite. It's immature, it's childish, it's vulnerable and susceptible, and therefore reacts very strongly to pain.

The false self is used by the narcissist to garner narcissistic supply from his human environment.

Narcissistic supply is any form of attention, both positive and negative. It is instrumental in the regulation of the narcissist's labile and fluctuating sense of self-worth.

Narcissistic supply is the drug that allows the narcissist to ignore or to cope with hurt and pain on the one hand, and to feel important, confident, and esteemed on the other hand.


Perhaps the most immediately evident trait of patients with narcissistic personality disorder is their vulnerability to criticism and disagreement. They are hypervigilant and hypersensitive, hunting and looking around for every hint of a slight or an insult or an offense.

Subject to negative input, real or imagined, or even to a mild rebuke, or even to a constructive suggestion or an offer to help. These patients feel injured, humiliated, and empty, and they react with disdain, devaluation of the source, rage and defiance.

In my book Malignant Self-Love, Narcissism Revisited, I've written to avoid such intolerable pain, the pain of criticism, disagreement, mockery, you will rebuke, chastisement, so to avoid such intolerable pain, some patients with narcissistic personality disorder socially withdraw and feign false modesty and humility to mask their underlying grandiosity.

Disocial and depressive disorders are common reactions to isolations and feelings of shame and inadequacy.

Due to their lack of empathy, disregard for others, exploitativeness, sense of entitlement, and constant need for attention, narcissistic supply, narcissists are rarely able to maintain functional and healthy interpersonal relationships.

Many narcissists are overachievers and ambitious. Some of them are even talented and skilled, but they are incapable of teamwork because they cannot tolerate setbacks. They are easily frustrated and demoralized, and they are unable to cope with disagreement and criticism.

Though some narcissists have meteoric and inspiring careers, in the long run all of them find it difficult to maintain long-term professional achievements and their respect and appreciation of their peers. They burn out and they end badly.

The narcissist's fantastic grandiosity, frequently coupled with a hypomanic mood, is typically incommensurate with his or her real accomplishments. This is the grandiosity gap.

The difference between the narcissist's self-important fantasies and his drab and shabby reality. There are many types of narcissists, the paranoid, depressive, phallic, and so on.

An important distinction is between the cerebral and the somatic narcissist.

The cerebral narcissist derives his narcissistic supply from his intelligence, intellect, academic achievements. The somatic narcissist derives his narcissistic supply from his physique, body, exercise, physical or sexual prowess, and romantic conquest.

Another crucial division within the ranks of patients with narcissistic personality disorder is between the classic variety, those who meet five of the nine diagnostic criteria in the DSM, and the compensatory kind, those whose narcissism compensates for deep-set feelings of inferiority and lack of self-worth.

Some narcissists are covert or inverted narcissists. As codependent, they derive their narcissistic supply from their relationships with not classic narcissists. They live vicariously, by proxy as it were, and the achievements of the classic narcissist in this dyad become their own achievements.

What is a treatment and prognosis of narcissism?

To summarize it in one paragraph, talk therapy, mainly psychodynamic psychotherapy or cognitive behavioral treatment modalities, is the common treatment for patients with narcissistic personality disorder.

The therapy goals cluster around the need to modify the narcissist's antisocial, interpersonally exploitative, abrasive and dysfunctional behaviors.

Such resocialization or behavior modification is rather successful, but this is not of course tantamount to healing or curing the underlying condition.

Medication is prescribed to control and ameliorate attendant conditions, such as mood disorders or obsessive compulsive disorders.

The prognosis for an adult suffering from narcissistic personality disorder is poor, though his adaptation to life and to others can improve markedly with treatment.

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