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.

Idealized, Devalued, Dumped

Narcissists have a cycle of overvaluation and devaluation, which is more prevalent in borderline personality disorder than in narcissistic personality disorder. The cycle reflects the need to be protected against the whims, needs, and choices of other people, shielded from the hurt that they can inflict on the narcissist. The overvaluation and devaluation mechanism is the most efficient one available to the narcissist, as the narcissist's personality is precariously balanced and requires inordinate amounts of energy to maintain. The narcissist's energies are all focused and dedicated to the task concentrated upon the source of supply he had identified.

Depressive Narcissist

Pathological narcissism is often considered a form of depressive illness, with the life of a typical narcissist punctuated with recurrent bouts of dysphoria, sadness, hopelessness, anhedonia, loss of the ability to feel pleasure, and clinical forms of depression. Narcissists react with depression not only to life crises but to fluctuations in narcissistic supply and to the internal dynamics that these fluctuations generate. There are several types of dysphoria and depression in pathological narcissism, including loss-induced dysphoria, deficiency-induced dysphoria, self-worth dysregulation dysphoria, grandiosity gap dysphoria, and self-punishing dysphoria. Many narcissists end up delusional, schizoid, or paranoid to avoid agonizing and knowing depression.

Addict Narcissists: Substance Abuse and Reckless Behaviors

Pathological narcissism is an addiction to narcissistic supply, which is the narcissist's drug of choice. Other addictive and reckless behaviors such as war-camelism, alcoholism, drug abuse, pathological gambling, compulsory shopping, reckless driving, and even compulsive lying, piggyback on this primary dependence on narcissistic supply. The narcissist's addictive behaviors take his mind off his inherent limitations and bridge the gap between his unrealistic expectations of life and his inflated self-image. There is no point in treating the dependence and recklessness of the narcissist without first treating the underlying personality disorder.

Narcissism: Genetics or Abuse, Nature or Nurture?

The debate over whether pathological narcissism is caused by genetics or upbringing is a confluence of both nature and nurture. Mental illness cannot be explained without considering our genetic makeup and neurophysiology. Narcissistic personality disorder is probably the interplay between a genetic template and the abuse and trauma heaped upon this inner computer. It is safe to attribute the development of narcissistic personality disorder mostly to the environment, to nurture not to nature.

Collapsed Narcissist, Collapsed Histrionic

Pathological narcissism is a post-traumatic condition that is a result of severe abuse by primary caregivers, peers, or authority figures. Narcissists require a form of narcissistic supply, and when the supply is deficient, they resort to several adaptive solutions. These solutions include the delusional narrative solution, the antisocial solution, the paranoid schizoid solution, the paranoid, aggressive or explosive solution, and the masochistic avoidance solution. In extreme cases, the collapsed narcissist or collapsed histrionic falls apart in a process of disintegration known as decompensation, which is accompanied by acting out.

Narcissism is Tiring Energy-depleting

Personality is a dynamic, ongoing process that is ever-evolving. The more primitive the personality, the less organized, the more disordered, the greater the amount of energy required to maintain it in a semblance of balance and function. Narcissists externalize most of the available energy in an effort to secure a narcissistic supply. The narcissist's constant fatigue and ennui, his short attention span, his tendency to devalue sources of supply, even his transformed aggression.

Signs You are Victim of Narcissistic Abuse, Not Common Abuse (Stress, Depression Management Webinar)

Narcissistic abuse is a subtype of abusive behavior that is pervasive, sophisticated, and can be practiced either covertly or overtly. Victims of narcissistic abuse often experience depression, anxiety, disorientation, and dissociative symptoms. This type of abuse can lead to complex post-traumatic stress disorder (CPTSD) and even elements of post-traumatic stress disorder (PTSD). The way individuals process and react to trauma can lead to either regression into infantile behaviors or personal growth and maturation, depending on their emotional regulation and maturity.

Narcissist's Addiction Atypical

There is little empirical research on the correlation between personality traits and addictive behaviors. Narcissism is an addiction to narcissistic supply, which is the narcissist's drug of choice. Narcissists derive pleasure from addictive and reckless behaviors, which sustain and enhance their grandiose fantasies. Narcissism is an adaptive behavior, while addiction is self-destructive and has no adaptive value.

Narcissist Loves his Disorder and Narcissistic Personality

Narcissists may modify their behavior to become more socially acceptable, but they never heal or get better because they have an emotional investment in their disorder. Narcissistic personality disorder serves two critical functions: it endows the narcissist with a sense of uniqueness and provides an alibi for their misconduct. Narcissists reject the notion that they are mentally ill or disturbed, and their disorder becomes an integral and inseparable part of their inflated self-esteem and grandiose fantasies. The narcissist is emotionally attached to their narcissistic personality disorder and loves their disorder passionately.

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