Narcissistic Personality Disorder (NPD)

 
Description
Narcissistic personality disorder is a mental disorder in which people have an inflated sense of their own importance and a deep need for admiration.  Those with NPD believe that they're superior to others and have little regard for other people's feelings.  But behind this mask of ultra-confidence lies a fragile self-esteem, vulnerable to the slightest criticism.  What they crave more than anything is attention, negative or positive.  They will pull everyone around them into their weird world where they are always the star.  Examples of NPD are Charles Manson, David Koresh, and Jim Jones.  NPD is sometimes called “The God Complex.”

Cause
It's not known what causes narcissistic personality disorder.  As with other mental disorders, the cause is likely complex.  In the past, experts believed excessive praise, admiration and indulgence from parents may lead to a pathologically inflated sense of self.  Today, however, psychiatrists believe parental neglect is more likely responsible.  Other evidence points to genetics or psychobiology — the connection between the brain and behavior and thinking.

Demographics
Approximately 1% of the general population suffer from NPD, mostly males.

Diagnosis
According to the mental health professional's handbook, Diagnostic and Statistical Manual of Mental Disorders (“DSM-IV”), five or more of the following criteria are required to make a diagnosis of NPD:

• Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
• Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
• Believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
• Requires excessive admiration
• Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
• Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
• Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
• Is often envious of others or believes that others are envious of him or her
• Shows arrogant, haughty behaviors or attitudes

Treatments
Treatments for NPD include a variety of pharmacologic, individual, and group approaches.  None, however, have been shown to be particularly effective.  Many people believe that since NPD is, as the name implies, simply a type of personality, it is not likely to change, just as most people’s personalities are pretty much set in early childhood. 

Prognosis
Since narcissists believe they can do no wrong, it is unusual for them to seek therapy, and those who do are generally reluctant to be truthful and open with mental health professionals.  Unfortunately, individuals treated for NPD tend to progress very slowly, and rarely remain in treatment long enough for significant improvement to be made.