Abnormal Psychology

Personality Disorders 611

Note that Patricia, in Case 13.8, said that people didn’t treat her with the re-

spect that she felt she deserved and that she didn’t feel adequately appreciated; peo-

ple with narcissistic personality disorder often report such feelings. Although all

of the dramatic/erratic personality disorders in Cluster B have criteria that involve

callous and demanding behaviors, narcissistic personality disorder stands out for its

features of grandiosity and a general lack of impulsivity or clear-cut self-destructive

behaviors. In addition, people with narcissistic personality disorder fear abandon-

ment less than do people with borderline personality disorder (Skodol, 2005).

Although Reiland had symptoms of each of the dramatic/

erratic personality disorders, her symptoms do not meet the

criteria for a diagnosis of narcissistic personality disorder;

her problematic behaviors were often impulsive and self-

destructive. Although her symptoms clearly met the criteria

for borderline personality disorder, a clinician would need ad-

ditional information to determine whether she had a comor-

bid dramatic/erratic personality disorder.

Understanding Narcissistic

Personality Disorder

As is true for histrionic personality disorder, very little re-

search has been conducted on narcissistic personality dis-

order, and so, again, we examine clinically based theories

about how the disorder arises. The same psychological and

social factors that are theorized to contribute to histrionic

personality disorder are also theorized to contribute to nar-

cissistic personality disorder. In fact, patients with these dis-

orders share the belief that they are special and impressive,

view other people as potential admirers, and are especially

sensitive to negative evaluation (Farmer & Nelson-Gray,

2005). However, the two disorders are not the same: People

with these disorders have distinct biases in their views of

themselves versus others, tend to hold different maladap-

tive beliefs, and rely on different maladaptive strategies (see

Table 13.20).

Table 13.18 • DSM-IV-TR Diagnostic Criteria for

Narcisstic Personality Disorder

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of

empathy, beginning by early adulthood and present in a variety of contexts, as indicated by fi ve

(or more) of the following:

(1) has a grandiose sense of self-importance (e.g., exaggerates achievements and talents,

expects to be recognized as superior without commensurate achievements)

(2) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

(3) believes that he or she is “special” and unique and can only be understood by, or should

associate with, other special or high-status people (or institutions)

(4) requires excessive admiration

(5) has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment

or automatic compliance with his or her expectations

(6) is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends

(7) lacks empathy: is unwilling to recognize or identify with the feelings and needs of others

(8) is often envious of others or believes that others are envious of him or her

(9) shows arrogant, haughty behaviors or attitudes

Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders,

Text Revision, Fourth Edition, (Copyright 2000) American Psychiatric Association.

Prevalence

• Approximately 1% of the general population will have narcissistic person-
  ality disorder at some point in their lifetimes.
  Comorbidity


• Common Axis I comorbid disorders are substance-related disorders and
  anorexia nervosa.


• Common comorbid personality disorders include paranoid personality
  disorder and the other Cluster B (dramatic/erratic) personality disorders:
  histrionic, borderline, and antisocial personality disorders.
  Onset


• As with other personality disorders, symptoms must emerge by early
  adulthood.
  Course


• People with narcissistic personality disorder may have a hard time adjust-
  ing to physical or occupational limitations that arise with advancing age.


• People with this disorder may function at a lower level than they seem
  capable of, because they are unwilling to risk possible defeat.
  Gender Differences


• Between 50% and 75% of those diagnosed with narcissistic personality
  disorder are male.
  Source: Unless otherwise noted, the source is American Psychiatric Association, 2000.

Table 13.19 • Narcissistic Personality Disorder

Facts at a Glance