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What is Narcissism?

Narcissistic personality disorder (NPD) is a pattern of grandiosity, need for admiration, and lack of empathy per the Diagnostic and Statistical Manual of Mental Disorders (DSM–5). The disorder is classified in the dimensional model of “Personality Disorders. NPD is highly comorbid (Comorbid = denoting or relating to diseases or medical conditions that are simultaneously present in a patient – “medically complex patients with severe comorbid conditions”) with other disorders in mental health. Persons with NPD can often present with impairment in maintaining work and relationships. NPD is highly prevalent in society. It is under the umbrella of Cluster B personality disorders, which include antisocial personality disorder, histrionic personality disorder, and borderline personality disorder. Cluster B typically presents with overtly emotional and unpredictable behavior.

Traits such as aggression, reduced tolerance to distress, and dysfunctional affect regulation is prominent in persons with NPD. Developmental experiences, negative in nature, being rejected as a child, and a fragile ego during early childhood may have contributed to the occurrence of NPD in adulthood. In contrast, excessive praise, including the belief that a child may have extraordinary abilities, may also lead to NPD.

Obtaining an accurate history can be somewhat challenging for persons with narcissistic personality disorder, given the variability of the individual. In the outpatient setting, individuals can be well related and high functioning, while in the inpatient setting, they can be some of the most aggressive and challenging patients. Most of the time, NPD patients encountering clinicians during emergencies, were more often than not, reported to behave aggressively. The aggression indicates the severity of the personality disorder, for example, the more aggression detected, the personality disorder is considered more severe. If you are a spouse of an individual with NDP then you will take the worst treatment from them as opposed to someone who is unfamiliar with the narcissist, and they deem fit to charm.

As Per the DSM, NPD includes: A pervasive pattern of grandiosity (fantasy or behavior), need for admiration, and with lack of empathy, beginning by early adulthood, as indicated by at least five of the following:

No standardized treatment has been established for persons with narcissistic personality disorder. There are no FDA-approved medications for the treatment of NPD, but some patients may benefit from the treatment of symptoms, including anxiety, depression, mood lability, transient psychosis, and impulse control issues. Antidepressants, including selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, have been used. Risperidone, an antipsychotic, has shown benefit in some patients. Some patients are given mood stabilizers like lamotrigine.

The prognosis, as discussed above, depends on the presence of comorbid disorders and the level of functioning of the patient. Aggression is often directly related to the severity of the disease; rather, the more aggressive the patient appears, the more severe is the personality disorder.

It has been well documented and those who experience regular interaction with a person with NPD will confirm that it is almost never heard of to have anyone with narcissistic personality disorder ever admit there is a single thing wrong with themselves. Therefore, it is considered impossible to hope for any positive change or acceptance of any kind of treatment.

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