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Narcissistic Personality Disorder Prevalence and Comorbidity

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

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

What is the difference between healthy narcissism and the pathological kind?

In my book Malignant Self-Love, I define pathological narcissism as a lifelong pattern of traits and behaviors which signify infatuation and obsession with one's self to the exclusion of all others and the egotistic and ruthless pursuit of one's gratification, dominance, and ambition.

Luckily for us, we are all narcissists to some degree.

But healthy narcissism is adaptive, it is flexible, empathic, and it causes elation and joy and happiness. It helps us to function and cope.

Pathologic narcissism, by comparison, is maladaptive. It is rigid, assisting, and it causes significant distress and functional impairment in a variety of contexts, such as family life or the workplace.

According to the Diagnostic and Statistical Manual and a variety of other publications, such as the Abstract of Psychotherapeutic Assessment and Treatment of Narcissistic Personality Disorder, well according to these publications, Narcissistic Personality Disorder is diagnosed in between 2 and 16% of a population in clinical settings or between 0.5% and 1% of the general population. So about 1% of the general population are narcissists.

The Diagnostic and Statistical Manual proceeds to tell us that most narcissists, at a minimum 50% but usually 75%, are men.

We must carefully distinguish between the narcissistic traits of adolescents and those of adults.

Narcissism is an integral part of the healthy personal development of adolescents.

Adolescence and pubescence is about self-definition, differentiation, separation for one's parents, and individuation. These processes inevitably involve narcissistic assertiveness, which is not to be conflated or confused with Narcissistic Personality Disorder.

As the narcissist grows old and suffers the inevitable attendant physical, mental, and occupational restrictions, Narcissistic Personality Disorder is actually exacerbated.

Studies have not demonstrated any ethnic, social, cultural, economic, genetic, or professional predilection or susceptibility for Narcissistic Personality Disorder, although narcissists tend to cluster, concentrate, and migrate to certain specific professions where public exposure is high and narcissistic supply is guaranteed.

Robert Millman, for instance, suggested a condition that he labeled acquired situational narcissism. He observed that there is a transient and reactive form of Narcissistic Personality Disorder in certain situations, such as under constant public scrutiny and exposure.

Narcissistic Personality Disorder is often diagnosed with other mental health disorders, and this is known as comorbidity. So it's very common to find Narcissistic Personality Disorder diagnosed in the same patient with mood disorders, eating disorders, and substance-related disorders.

Patients with Narcissistic Personality Disorder are frequently abusive and prone to impulsive and reckless behaviors, and this is known as dual diagnosis.

The comorbidity of Narcissistic Personality Disorder with other personality disorders, such as the histrionic, the borderline, the paranoid, and most definitely the antisocial personality disorder, psychopathy, this comorbidity is pretty high.

Narcissistic Personality Disorder is often misdiagnosed as bipolar disorder in the manic phase, or as Asperger's disorder, or as generalized anxiety disorder, and vice-versa.

Though the personal styles of patients with Cluster B Personality Disorders, these styles resemble each other, they also substantially differ.

The Narcissist is grandiose, his trinity is coquettish, the antisocial, the psychopath, is callous, and the borderline is needy and clinking.

In my book Malignant Self-Love, I wrote, as opposed to patients with a borderline personality disorder, the self-image of the Narcissist is stable, he or she are less impulsive and less self-defeating and self-destructive, and less concerned with abandonment issues, they are not as clinking as borderlines.

And contrary to the histrionic patient, the Narcissist is achievements-oriented, and proud of his or her possessions and accomplishments.

Narcissists also rarely display their emotions as histrionics do, and they hold their sensitivities and needs of others in utter contempt.


According to the DSM, both Narcissists and Psychopaths are tough-minded, gleamed, superficial, exploitative, and unempathic, but Narcissists are less impulsive, less aggressive, and less deceitful. Psychopaths rarely seek Narcissistic supply as opposed to Narcissists, and as opposed to Psychopaths, few Narcissists are criminals.

Patients suffering from the range of obsessive-compulsive disorders are committed to perfection and believe that only they are capable of attaining it, but as opposed to Narcissists, they are self-critical and far more aware of their own deficiencies, flaws, shortcomings, and limitations.

So Narcissistic Personality Disorder has few things in common with a variety of other mental health disorders, but it should be differentiated from them, and this we call differential diagnosis.

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Narcissist: Is He or Isn't He?

Narcissism is a spectrum of behaviors, from healthy to pathological, and the Diagnostic and Statistical Manual specifies nine diagnostic criteria for narcissistic personality disorder (NPD). A malignant narcissist is someone who has NPD and wreaks havoc on themselves and their surroundings. They feel grandiose and self-important, exaggerate accomplishments, and demand recognition as superior without commensurate achievements. They require excessive admiration, adulation, attention, and affirmation, and are interpersonally exploitative, devoid of empathy, and constantly envious of others.


Can You Diagnose Your Narcissist?

Narcissistic Personality Disorder (NPD) can only be diagnosed by qualified mental health professionals using the criteria outlined in the Diagnostic and Statistical Manual (DSM). Many people incorrectly label others as narcissists based on personal experiences or traits, which can lead to misunderstandings about the disorder. Key characteristics of narcissists include a sense of grandiosity, a need for excessive admiration, entitlement, lack of empathy, and a tendency to exploit others. It is important to refrain from diagnosing or labeling individuals without proper qualifications, as this can perpetuate misconceptions about mental health disorders.


NPD Narcissist, Or Merely Narcissistic Sick, Or Just A Hole

Narcissistic personality disorder (NPD) is a rare clinical condition, affecting approximately 1% to 3% of the population, and should not be confused with individuals who merely exhibit narcissistic traits or behaviors. The distinction between true narcissists and those with narcissistic styles is crucial, as many people display narcissistic tendencies without meeting the criteria for NPD. Recent trends indicate a rising number of diagnosed female narcissists, often exhibiting both narcissistic and borderline traits, which can lead to more dangerous behaviors compared to their male counterparts. The pandemic is expected to exacerbate mental health issues, potentially leading to a significant increase in personality disorders and psychotic conditions, highlighting the need for better understanding and differentiation of narcissistic behaviors.


Covert Narcissist = Borderline+Psychopath+Passive-Aggressive

Narcissism exists on a spectrum, with individuals displaying varying degrees of narcissistic traits, personality styles, and disorders. The distinction between narcissistic personality disorder and narcissistic personality style is crucial, as the former is dysfunctional and self-destructive, while the latter can be a positive adaptation that allows for social functioning. Narcissists often lack emotional empathy and perceive others as extensions of themselves, leading to exploitative behaviors and a reliance on narcissistic supply for self-regulation. Covert narcissists, in particular, may exhibit a fragile self-image and can be more dangerous due to their hidden nature, often engaging in passive-aggressive behaviors and manipulation.


Reverse Your Helplessness in Narcissistic Abuse (with Jacqui Yates, Circles)

Narcissism exists on a spectrum, with healthy narcissism contributing to self-esteem and self-confidence, while pathological narcissism significantly impairs interpersonal relationships. Pathological narcissism can be categorized into three manifestations: narcissistic style, which refers to unpleasant behaviors; narcissistic trait domains, which include specific traits like antagonism and obsessive-compulsive features; and narcissistic personality disorder, a severe mental illness that is distinct and not on the same spectrum as the other two. The confusion often arises when people mislabel others with narcissistic traits or styles as having narcissistic personality disorder, which is a clinical diagnosis. Ultimately, narcissistic personality disorder is a rigid and maladaptive condition that does not share a continuum with narcissistic traits or styles.


Hey, Millon, I Suddenly See Narcissists Everywhere! (Book: Personality Disorders in Modern Life)

Pathological narcissism is often confused with narcissistic traits, leading to a perception that narcissists are more prevalent than they actually are, with only 1-2% of the population diagnosed with narcissistic personality disorder. There exists a spectrum of healthy narcissism, which is distinct from pathological narcissism, and this confusion contributes to the misidentification of individuals with narcissistic styles as having a disorder. Cultural factors also play a significant role in how narcissism is expressed and perceived, with individualistic societies emphasizing personal achievement and collectivist cultures attributing success to group support. Understanding these distinctions is crucial for accurately diagnosing and discussing narcissism in various contexts.


Think You Know Narcissists, Borderlines? Think Again! (With Ruan de Witt)

Narcissism can be understood as a complex of traits and behaviors, with a distinction between narcissistic style and narcissistic personality disorder (NPD). The former is increasingly common as a coping mechanism in a self-centered society, while the latter involves severe disruptions in personality and functioning, often stemming from childhood trauma. The prevalence of NPD is now seen as roughly equal between men and women, with a concerning rise in narcissistic traits among women, often as a reaction to trauma. Relationships with narcissists can be toxic, characterized by phases such as love bombing, grooming, and shared fantasy, ultimately leading to complex trauma for the partner if they remain in the relationship without adjusting their expectations or reframing the situation.


Narcissistic Personality Disorder Diagnostic Criteria (DSM IV-TR)

Narcissistic Personality Disorder (NPD) is an extreme form of pathological narcissism, which is one of four personality disorders in Cluster B. The International Classification of Diseases, Edition 10, does not recognize NPD as a personality disorder, while the Diagnostic and Statistical Manual, 4th Edition, text revision, provides a diagnostic criteria for NPD. The DSM defines NPD as an all-convasive pattern of grandiosity in fantasy or behavior, need for admiration or adulation, a lack of empathy, usually beginning by early adulthood and present in various contexts such as family life or work. The narcissist feels grandiose and self-important, is obsessed with fantasies of unlimited success, and is devoid of empathy.


Your Empathy as Narcissistic Injury: Narcissist Never Learns, No Insight

Narcissists reject empathy and intimacy because it challenges their grandiosity, and they become paranoid and aggressive when someone tries to be intimate with them. Narcissists lack empathy and access to positive emotions, leading to a truncated version of empathy called "cold empathy." Narcissists are self-aware but lack the incentive to get rid of their narcissism, and therapy is more focused on accommodating the needs of the narcissist's nearest and dearest. Cold Therapy is experimental and limited, as it removes the false self but does not develop empathy or improve the narcissist's interpersonal relationships.


Can Narcissism be Cured?

Pathological narcissism is difficult to cure, and most narcissists resist psychotherapy. However, some progress has been made in effecting small changes in personality disorders through talk therapy and medication. The earlier the therapeutic intervention, the better the prognosis, and aging tends to moderate or even vanquish some antisocial behaviors associated with pathological narcissism. The existence of empathy is a serious predictor of future psychodynamics, and the prognosis for a classical narcissist with grandiosity, lack of empathy, and all is not good as far as long-term, lasting, and complete healing.

Transcripts Copyright © Sam Vaknin 2010-2024, under license to William DeGraaf
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