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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.

If you enjoyed this article, you might like the following:

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.


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.


Self-Aware Narcissist: Still a Narcissist

Narcissism is pervasive and defines the narcissist's waking moments, infiltrating and permeating their dreams. Narcissists only admit to a problem when they are abandoned, destitute, and devastated. Narcissistic behaviors can be modified using talk therapy and pinpointed medication conditioning, but there is a huge difference between behavior modification and a permanent alteration of a psychodynamic landscape. Narcissism may improve with age, but it is rare.


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.


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.


Narcissists Hard to Spot

Narcissistic personality disorder is difficult to isolate with certainty, and it is important to distinguish between inherent traits and reactive patterns. Narcissism is considered pathological only when it becomes a rigid personality structure with primitive defense mechanisms and leads to dysfunctions in one or more areas of life. Pathological narcissism is the art of deception, and the narcissist projects a false self to manage social interactions. Victims of narcissists often find themselves involved before discovering the narcissist's true nature, and the narcissist emits subtle signals even on a first or casual encounter.


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.


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.


Your Narcissist: Madman or Genius? (Based on News Intervention Interview)

Narcissists often claim to be geniuses, but Narcissistic Personality Disorder is a serious mental health problem. It is difficult to tell the difference between a genius and a madman, but the scientific method can help by applying a test of falsifiability. Narcissists often make predictions that fail time and again, while geniuses' predictions hold water for long stretches of time. Narcissism is a problem of nurture, a problem of the environment, and abuse and trauma suffered in early childhood.


Narcissists and Codependents: Same Problems, Different Solutions

Codependence and narcissism are pathological reactions to childhood abuse and trauma. The codependent has a realistic assessment of herself but a fantastic view of others, while the narcissist has a fantastic view of himself but a penetrating view of others. The codependent seeks validation to restore a sense of reality, while the narcissist seeks narcissistic supply to enhance his grandiosity. Inverted narcissists are a subtype of covert narcissists who team up with classic narcissists to obtain vicarious supply. The overwhelming majority of narcissists have codependent traits and are dependent on other people for their sense of self-worth, self-esteem, self-confidence, and self-image.

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