Narcissistic personality disorder is characterized by exaggerated sense of self-importance with a lack of sustained positive regard for others.
👉Around 0.5%in general population.
👉1-3%in clinical settings.
No evidence is available. But some aspects of narcissism might be related to monoamine function abnormalities at the mesolimbic reward systems.
High parental expectations & harsh criticism of the child is present in the family.
Narcissistic Personality disorder is not included in ICD-10. It is mentioned only in category: “other specific personality disorders”
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
8.Often envious to others or believes that others are envious of him/her.
9.Shows arrogant, haughty behaviors or attitudes.
Patients with narcissistic personality disorder have a high overlap with:
👉Histrionic personality disorder
👉Borderline personality disorder
👉Antisocial personality 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.
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
👉Less capable of concentrating on work & career
👉Devoid of guilt feelings
👉Have a capacity for empathy.
👉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.
For episodes of mood & anxiety symptoms:
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.
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- New Oxford Textbook of Psychiatry(2nd edition).
- ICD-10 Classification of Mental and Behavioural Disorders.