Narcissistic Personality Disorder

Narcissistic personality disorder is characterized by exaggerated sense of self-importance with a lack of sustained positive regard for others.

Epidemiology:

👉Around 0.5%in general population.
👉1-3%in clinical settings.

Aetiology:

Biological:

No evidence is available. But some aspects of narcissism might be related to monoamine function abnormalities at the mesolimbic reward systems.

Developmental:

High parental expectations & harsh criticism of the child is present in the family.

Clinical Features:

Narcissistic Personality disorder is not included in ICD-10. It is mentioned only in category: “other specific personality disorders”

DSM-V criteria:

5 or more should be present to make the diagnosis:

1. Grandiose sense of self-importance.

2.Fantasies of unlimited success, power, brilliance, beauty or ideal love.

3.Believes that he/she is special & unique and can only be understood by high-status people.

4.Requires excessive admiration.

5.Has a sense of entitlement.

6.Is interpersonally exploitative

7.Lacks empathy

8.Often envious to others or believes that others are envious of him/her.

9.Shows arrogant, haughty behaviors or attitudes.

Comorbidity:

👉Depression
👉Dysthymic disorder
👉Anorexia nervosa
👉Substance Abuse

Patients with narcissistic personality disorder have a high overlap with:

👉Histrionic personality disorder
👉Borderline personality disorder
👉Antisocial personality disorder

Differential Diagnosis:

Bipolar Disorder:

As compared to Bipolar Disorder, mood swings in Narcissistic personality disorder are of limited duration, insight is maintained & the general integrity of the personality is preserved.

Borderline Personality Disorder:

As compared to borderline personality disorder, patients with Narcissistic Personality Disorder have:
👉Better impulse control
👉Greater social adjustment
👉Greater anxiety tolerance
👉Less suicide attempts
👉Lesser psychotic episodes

Antisocial Personality Disorder:

They are:

👉More impulsive
👉Less capable of concentrating on work & career
👉Devoid of guilt feelings

Obsessive Compulsive Personality Disorder

👉Have a capacity for empathy.

Histrionic Personality Disorder:

👉Concern & love for others is present.

Course & Prognosis:

👉Patients often become depressed or hypomanic during middle age because of vicious cycles of frustrations & disappointment & diminishing narcissistic supplies.
👉Hypochondriasis & anxiety disorders are frequent complications.

Treatment:

For episodes of mood & anxiety symptoms:
👉Antidepressants
👉Anxiolytics
👉Mood stabilizers

Psychotherapy:

Treatment inevitably arouses serious counter transference problems because of emotional detachment, demanding behaviour & devalutative actions of narcissistic patients.

⭐Therapist should retain an empathic & non-judgmental attitude.

If you have any questions or concerns, please write in the comment box…

Reference:

  • New Oxford Textbook of Psychiatry(2nd edition).
  • ICD-10 Classification of Mental and Behavioural Disorders.

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