Narcissistic Personality Disorder (NPD) is defined by extreme self-absorption and false self-perception. Even though it affects only a small portion of the population (about 1%), NPD is a destructive disorder both for the affected individual and for his family.
NPD exhibits itself primarily in the sufferer’s perception of himself. He has an exaggerated sense of self-importance and, at the same time, has continuing fantasies of fame, power, and brilliance. In short, the NPD sufferer perceives himself as special and unique and only allows himself to interact with people of perceived equal brilliance or greatness. Unfortunately, the narcissist cannot or will not change his behavior because he cannot see the errors in his perceptions.
Not surprisingly, an NPD sufferer believes he is perfect in all aspects. Very little can make a dent in this belief, with the occasional exception of serious illness. As a perfect person, the narcissist is not susceptible to illness or injury, so any sort of hospitalization is upsetting to his psyche. In a continuing effort to convey his perfection to others, the narcissist will only allow the most senior doctor or specialist in the hospital to treat him if he does become seriously ill. Lower doctors and other staff are used only to reinforce his perceived superiority.
In addition to self-importance and absolute perfection, a narcissist believes he is complete unto himself. He needs no one and will describe his life as if no other person exists (i.e. he does all the work, he makes all the money, and he earns all the accomplishments). If others exist, they are envious of him and his perfection. Sadly, this perception is false, as most narcissists are disliked by those around them. For this reason, as NPD sufferers approach middle age, they become depressed and have a more difficult time functioning in society. The depression can also be attributed to an aging body and physical appearance and other changes that come with age.
Along with personal problems such as depression, an NPD sufferer has difficulty interacting with others. He wants constant admiration, and it is the volume and the frequency of the praise that matters, not the sincerity. This need is due, in part, to the sense of entitlement a person with NPD has. He believes that he should get more than he gives, or that his work produces greater results than others’ work. As a result, the NPD sufferer believes his time is far more valuable than anyone else’s.
Another fault an NPD sufferer has is his ability to listen and relate to other people. He is devoid of empathy and cannot comprehend others’ problems or emotions. For him, it is as if other people do not have feelings or problems worthy enough for him to comprehend. Since he cannot process the emotions and opinions of those around him, he believes he is doing an exceptional job or that he is well liked despite mounting evidence to the contrary. Thus, his self-reports are unreliable, as he cannot see reality clearly.
Because NPD is a disorder, the word “sufferer” is used when describing a patient, despite the sense that his symptoms are self-produced. Nevertheless, NPD is a mental condition that can be treated. Making an NPD sufferer admit he needs treatment, however, is nearly impossible because of the nature of the disorder. Severe cases of NPD can merit hospitalization, mainly to provide a stable environment for the patient. Because people who have NPD usually also suffer from Axis I mental problems (depression, anxiety, anger), hospitalization can provide a reprieve from the chaotic lifestyles and/or acting out that accompanies a severe narcissistic patient.
Although no one knows why NPD develops in a person, many theories point to childhood. The possible causes range from infantile abuse or neglect to over-indulgence by the parents – this wide differential proving how little is known about the source of NPD. Despite not knowing the causes of NPD, the goals of treatment or therapy are to make the patient have a clearer perception of reality. For example, the patient must realize that he does not need to be a perfectionist or ideal in every way but that, instead, he is allowed to be an individual with flaws and quirks. Another goal of therapy is to encourage the patient to see other people as individuals like himself and for him to recognize that everyone has flaws. Lastly, treatment for NPD encourages the patient to rid himself of the coping mechanisms he uses. For example, the different forms of condescension, or his need to only see the best doctor, go to the best schools, associate with only a certain level of people are all coping mechanisms that therapists try to treat.
While the process of therapy is difficult for a sufferer of NPD, it can help lessen the effects of the disorder. Narcissistic Personality Disorder, however, is a very difficult disorder for the sufferer and his family. Between the constant demands by the sufferer on those around him and the almost inevitable depression he faces, a positive resolution to this conflict is rare. Nevertheless, as psychology progresses, more will be learned about the disorder and ways to treat it.
