Narcissistic Personality Disorder

Excerpt

Narcissistic personality disorder (NPD) is a pervasive pattern of grandiosity, a need for admiration, a lack of empathy, and a heightened sense of self-importance. Individuals with NPD may present to others as boastful, arrogant, or even unlikeable. NPD is a pattern of behavior persisting over a long period and through a variety of situations or social contexts and can result in significant impairment in social and occupational functioning. Additionally, NPD is often comorbid with other psychiatric illnesses, which may further worsen independent functioning. Unfortunately, treatment modalities for NPD are limited in both availability and efficacy.

The term narcissism was first described by the Roman poet Ovid in his work Metamorphoses: Book III. This myth centers around Narcissus, a character cursed to fall in love with his reflection. However, it was not until the late 1800s that narcissism was used to define a psychological mind state.

The psychologist Havelock Ellis first used the term narcissism in 1898 to link the description of Narcissus to behaviors he observed in his patient. Shortly after, Sigmund Freud labeled "narcissistic libido" in his book Three Essays on the Theory of Sexuality. Psychoanalyst Ernest Jones described narcissism as a character flaw. In 1925, Robert Waelder published the first case report of pathological narcissism and described it as "narcissistic personality." Despite these developments, NPD was not included in the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I). It was not until 1968, during the era of the second edition of the DSM (DSM-II), that Heinz Kohut termed narcissism.

In the DSM, personality disorders have been categorized into clusters based on shared characteristics; this model persists into the current DSM (fifth edition, text review) (DSM-5-TR). This categorization includes cluster A, cluster B, and cluster C personality disorders.

1. Cluster A: Personality disorders with odd or eccentric characteristics, including paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder

2. Cluster B: Personality disorders with dramatic, emotional, or erratic features, including antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder

3. Cluster C: Personality disorders with anxious and fearful characteristics, including avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder

Despite the historical context of using the cluster system, there are limitations when approaching personality disorders in this manner, and it is not consistently validated in the literature.