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NARCISISTIC PERSONALITY DISORDER

Symptoms and Signs

The diagnostic criteria for narcisistic personality disorder is characterized as a pervasive pattern of grandiosity, need for admiration, and lack of empathy. These individuals display an exaggerated sense of self-importance, which is manifest in a pretentious, boastful overestimation of abilities.

Brief reactive psychoses may occur, which are experienced as a loss of the sense of continuity of oneself as worthwhile and lovable in the face of a current disappointment, criticism.

Depression is common, as is chronic intense envy. Defensive self-delusion or lying to oneself by distorting the facts is common.

Differential Diagnosis

Individuals with narcisistic personality disorder lack the impulsivity, self-destructiveness, and instability.

Epidemiology

Prevalence estimates for narcisistic personality disorder are 1% in the general population.

Etiology & Pathogenesis

In normal psychological development, all very young children have an exaggerated sense of their own importance as well as an idealized view of parental figures as protective, powerful, and immortal.

Treatment

Long-term psychoanalytic psychotherapy and psychoanalysis have been attempted with these patients.

Narcisistic Personality Disorder in Medical Practice

Narcisistic patients try to sustain an image of perfection and personal invincibility for themselves.

Physical illness may shatter this illusion, and a patient may lose the feeling of safety inherent in a cohesive sense of self. This loss precipitates a panicky sensation of insecurity.

The narcisistic individual shares with the histrionic personality a concern about loss of admiration and approval, but the person with narcissistic personality disorder shows a more disturbed response to illness. The histrionic patient's idealization of the physician stands in contrast to the narcissistic patient's frequent contemptuous disregard for the physician, who is denigrated in a defensive effort to maintain a sense of superiority and mastery over illness.

An initial approach of support followed by step-by-step confrontation of the patient's vulnerabilities may enable the patient to deal with the implications of illness.

The increased self-confidence may reduce the patient's need to attack the health care team in a misguided effort at psychological self-preservation and eases the pressure to provide perfect care, since the patient's antagonistic feeling.