Pathological Narcissism.

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When certain patterns of behavior, or your inner experience, become continuing, pervasive, and inflexible and deviates from what your culture expects, you may have a personality disorder. Narcissistic personality disorder involves an extreme need for admiration, delusions of grandeur or grandiosity, and a lack of empathy.
This particular disorder is rarely diagnosed because those with Narcissistic Personality Disorder do not believe there is anything wrong with them. Lacking empathy, the narcissist blames their problems on others. What brings the narcissist to therapy is most likely extreme impairment in social relationships or a deteriorating job functioning.
One great paradox of narcissists is that despite their beliefs in their superiority, they often are very vulnerable to challenges to their self-esteem. Narcissists need to feel they are better than others in order to feel okay about themselves. This dichotomy results in a high sensitivity to criticism. They often meet perceived attacks with rage.
Even when forced into counseling, the narcissist likely will continue to insist that the problems are caused by others. The DSM lists nine characteristics of narcissistic personality disorder. Having five or more of the characteristics is required to receive the diagnosis. I have paraphrased these from the APA DSM-5.
1. Excessive self-importance, grandiosity.
They expect that everyone will recognize their superiority to others. The narcissist boasts, brags, and exaggerates their accomplishments and are shocked when other people do not recognize their superiority. There is an exception to this if they actually are superior. As the saying goes, it’s not bragging if you can do it.
2. They live in a fantasy world of power and success.
They are preoccupied with fantasies of limitless excesses, absolute power, unrivaled beauty, and brilliance, or ideal love. Narcissists are prone to compare themselves favorably with famous people.
3. The narcissist has a firm belief that they are better than others.
He believes that he should only associate with other superior beings. They expect to attend the best schools, drive the best car, and live in the best neighborhood. Believing they are better than others, they are quick to find fault with the accomplishments of others.
4. The narcissist can’t live without the worship or admiration of others.
Narcissists are often desperate for recognition from others. They expect to be the center of attention and are shocked when others don’t notice them. Narcissists will fish for compliments and be insulted when they feel underappreciated.
5. The narcissist believes they deserve special treatment.
Because they believe they are superior to others, they expect their needs to receive the highest priority. They have a sense of entitlement and a belief that the rules should not apply to them. They see themselves as too important to have to wait for their turn or to stand in line.
6. Give the narcissist a chance he will use you to meet his needs.
Given his sense of entitlement, it’s not surprising; narcissists have no qualms about using others. Sometimes this is a lack of sensitivity, but it may also be rooted in their belief that they are more important and deserving than others. Don’t expect a narcissist to feel guilty for taking advantage of others.
7. Empathy is foreign to narcissists.
The narcissist is incapable of seeing things from others point of view. He can’t see why the feelings or needs of others should matter and expects others to be fully committed to meeting his needs. While they will talk at great lengths about their concerns, they will have no patience to listen to the problems of lesser beings.
8. Narcissists feel entitled to the most and the best.
The narcissist believes others hate him and are jealous. He believes he is entitled to the biggest and best. If someone else has something of value, the narcissist believes it should belong to them.
9. The narcissist excels at arrogance.
The narcissist criticizes everyone. They are quick to use derogatory labels such as stupid, lazy, fat, and rude.
Having read those nine characteristics, you probably have a pretty good mental picture of a narcissist. While I referred to the narcissist as he, it is possible to encounter a narcissistic she also. Some of the characteristics of this and other personality disorders sound like immaturity. To use the personality disorder label, we require that this disorder first begins in early adulthood.
In adolescents, these characteristics may not be fixed and would be described as narcissistic traits. In the adult population, it is estimated that up to 6% of the population have severe enough narcissistic traits to receive the diagnosis of Narcissistic Personality Disorder. About 75% of those with Narcissistic Personality Disorder are men. One possible explanation for the high rate of narcissism in men is our culture’s emphasis on competition and winning. More on that in an upcoming post.
Narcissistic Personality Disorder overlaps and co-occurs with depression, especially Persistent Depressive Disorder, and hypomania in bipolar disorder. People with Narcissistic Personality Disorder often also have Histrionic, Borderline, Antisocial, and Paranoid Personality Disorders.

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