At what point is someone considered to have narcissistic personality disorder?

Question: My question is about narcissistic personality disorder. Since everyone has some narcissistic elements to their personality, at what point is someone considered to have NPD? Also, what are the chances of such a person recognising their condition and wanting to do something about it? Jenny

Answer (1)
As with most "disorders", it becomes a disorder when it starts to interfere with the person's day to day functioning. e.g., relationships with work colleagues, and relationships with relatives or their partner. Most personality disorders are extremely resistant to change. Of all the personality disorders, narcissistic is one of the most resistant. Due to its nature, the person is very reluctant to recognise that their behaviour is problematic, namely because of their inability to empathise with how their behaviour impacts on those around them. They tend to have an unjustified sense of entitlement and a reduced sense of responsibility, which makes change near impossible. It also makes them frustrating to those around them (including psychologists!)

Answer provided by Graham Cox, Psychologist

Answer (2)
You are quite right. A certain degree of narcissism (self centred interest) is necessary for our very survival and advancement in life. It's difficult to be precise about exactly when narcissism changes from normal to pathological, as degrees vary even within the same person, from situation to situation and from time to time. Life is about shades of grey, not black and white. However, as fairly reliable indications, narcissism is considered pathological when the person afflicted has little or no ability to empathise with other people, using them as basically as need satisfying objects. ie: 1) merely as a dispensible and replaceable audience, to admire, validate and do their bidding. 2) Using others as personal possessions, in any way one chooses, totally without regard or concern for their needs. 3) There is usually an inability to accept any responsibility for mistakes or acknowledge personal shortcomings. 4) A delusional belief in their own central importance, great talents and astounding abilities. 5) They can have a frightening sense of entitlement to get what they want, regardless of what this may mean.

They rarely present for treatment because of the central conviction that if there is a problem, it lies with anyone and everyone else, except themselves. If they do present, it is usually because some catastrophic event has happened in their lives, that has caused the bottom to drop out of their world. The narcissistic defenses they employ against reality, temporarily fail them and they fall into a slump of depression and despair, which is what is constantly defended against in the first place. Often in merely supportive therapy, where the central problem is not recognised for what it is, these people rapidly resurrect their narcisstic defenses, become grandiose and contemptuous once more and haughtily leave, as insightless as they came. It is a treatable condition but one which is fraught with unusual difficulties and needs quite specialised training if it is to be successful.

Answer provided by David White, Psychotherapist

Answer (3) Someone could be considered to be narcissistic when they have a disproportionate degree of self-concern. Inside they may have a sense of (or fear of) insufficiency, shame and weakness that the external self-importance is covering over. As with everyone, recognition usually comes well before attempting to do something about an issue. Having some emotional safety and trust in the other has to come before we reach out and open up.

Answer provided by Fiona Halse, Psychotherapist

Answer (4) This label of NPD is not without difficulties. For example, here is a list of signs of low emotional quotient (EQ) which also describe significant aspects of NPD and a lot else besides:

  • Doesn't take responsibility for his feelings; blames you or others for them.
  • Can't put together three word sentences starting with "I feel..."
  • Can't tell you why she feels the way she does, or can't do it without blaming someone else.
  • Attacks, blames, commands, criticizes, interrupts, invalidates, lectures, advises and judges you and others.
  • Tries to analyze you, for example when you express your feelings.
  • Often begins sentences with "I think you..."
  • Sends "You messages" disguised as "I feel messages" For example, "I feel like you......"
  • Lays guilt trips on you.
  • Withholds information about or lies about his feelings. (Emotional dishonesty)
  • Exaggerates or minimizes her feelings.
  • Lets things build up, then they blow up, or react strongly to something relatively minor.
  • Lacks integrity and a sense of conscience.
  • Carries grudges; is unforgiving.
  • Doesn't tell you where you really stand with her.
  • Is uncomfortable to be around.
  • Acts out his feelings, rather than talking them out.
  • Plays games; is indirect or evasive.
  • Is insensitive to your feelings.
  • Has no empathy, no compassion.
  • Is rigid, inflexible; needs rules and structure to feel secure.
  • Is not emotionally available; offers little chance of emotional intimacy.
  • Does not consider your feelings before acting.
  • Does not consider their own future feelings before acting.
  • Is insecure and defensive and finds it hard to admit mistakes, express remorse, or apologize sincerely.
  • Avoids responsibility by saying things like: "What was I supposed to do? I had no choice!"
  • Is pessimistic and often believes the world is unfair.
  • Frequently feels inadequate, disappointed, resentful, bitter or victimized.
  • Locks himself into courses of action against common sense, or jumps ship at the first sign of trouble.
  • Avoids connections with people and seeks substitute relationships with everything from pets, computers to imaginary beings.
  • Rigidly clings to his beliefs because he is too insecure to be open to new facts.
  • Can tell you the details of an event, and what they think about it, but can't tell you how she feels about it.
  • Uses his intellect to judge and criticize others without realizing he is feeling superior, judgmental, critical, and without awareness of how his actions impact others' feelings.
  • Is a poor listener. Interrupts. Invalidates. Misses the emotions being communicated. Focuses on "facts" rather than feelings.

Answer provided by Peter Fox, Clinical Psychologist

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