Narcissistic Personality Disorder
Persons with Narcissistic Personality Disorder or NPD have a pervasive pattern of grandiosity and an inflated sense of self importance. (First, Tasman 2005) These people have a deep need for admiration from others, even though they believe that they are superior to others and have little regard for people’s feelings. People who have a narcissistic personality disorder may be described as being rude, snobbish, in-considerate, critical, cocky, self-centered, demanding, and manipulative. The criteria used for diagnosing a person with Narcissistic Personality Disorder, come from the DSM IV, and include the following:
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 FIVE (or more) of the following: (First, Tasman 2005)
- has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
- is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
- 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)
- requires excessive admiration
- has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
- is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
- lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
- is often envious of others or believes that others are envious of him or her
- shows arrogant, haughty behaviors or attitudes
It occurred to me, based on these personality traits, it is likely that persons with Narcissistic Personality Disorder suffer from stress related illnesses. Does NPD cause health problems? Upon starting my research on Narcissistic Personality Disorder, I saw several stories discussing the possibility of NPD being removed from the DSM-V. Another question arose from this observation. I began to wonder why Narcissistic Personality Disorder was being considered for removal from the DSM-V. Is there criticism surrounding the accuracy of diagnostic criteria? This began my search for peer reviewed articles that addressed the effect NPD has on a people’s health, and the challenges NPD criterion pose to accurate diagnosis.
People suffering from Narcissistic Personality Disorder, struggle with a number of interpersonal problems. Social interactions may be stressful to them, because people view them more negatively (Paulhus DL, 1998) Narcissists often lack empathy and react with hostility, and sometimes aggression, when they perceive a threat to their self-image. (Bushman, Baumeister 1998) Through researching the possibility of Narcissism causing health problems, I found a study that was conducted on the effects that NPD has on cortisol levels. This study presents strong evidence that higher cortisol levels were found in men with Narcissistic Personality Disorder. The higher levels didn’t seem to be present in women with NPD. (Reinhard, Konrath, Lopez, Cameron 2012) The hypothesis for the cortisol was stated as follows:
Given the cardiovascular reactivity associated with maintaining positive self-views, it stands to reason that a relationship between narcissism and hypothalamic-pituitary-adrenal reactivity would also exist. The hypothalamic-pituitary-adrenal (HPA) axis represents the key stress-response system in the body, and one marker of its activation is concentrations of salivary cortisol. During stressful events, there are acute increases of cardiovascular reactivity associated with increased cortisol. Research has found sex differences in narcissism and also in cortisol reactivity in response to stressors. Males tend to score higher on narcissism, and males also have larger acute increases in cortisol after stressors. So it is possible that male narcissists would be especially susceptible to increased HPA reactivity. (Reinhard, Konrath, Lopez, Cameron 2012)
The method for this research began with recruiting participants from a Midwestern and a SouthwesternAmericanUniversity. They ended up with 106 volunteers (79 females and 27 males). At the beginning of the study, each of the participants gave a baseline saliva sample. This is an effective and valid way of measuring cortisol levels. Twenty five minutes after the first sample was given, each participant was asked to give another saliva sample. This was to ensure accuracy in determining the cortisol levels in the participants. Narcissism was measured using the 40 item Narcissistic Personality Inventory. An example of the response given is the narcissistic response “If I ruled the world it would be a better place” or the non-narcissistic response “The thought of ruling the world frightens the hell out of me”. Healthy narcissism and unhealthy narcissism was determined by the scores from these questions. They found that unhealthy narcissism was associated with marginally higher cortisol in females, and significantly higher cortisol in males. In fact, unhealthy narcissism yielded more than twice the amount of cortisol in males than in females. High cortisol levels can cause belly fat, fatigue, high blood pressure, irritability, weakness, and may lead to more serious illnesses such as Cushing’s syndrome. (Oguejiofo, 2010)
An article titled Pathological Narcissism and Narcissistic Personality (Pincus, Lukowitsky, 2010) explains that the current criterion problem has much to do with the criteria revision that occurred in the DSM- III. Changes to Narcissistic Personality Disorder in the DSM-III eliminated many of the vulnerable criteria making it more one sided. The DSM-III focused on the criteria surrounding grandiosity, power, beauty, success, self-importance, exploitativeness, arrogant, haughty behaviors, etc., and eliminated many of the criteria surrounding vulnerability, shameful reactivity, humiliation in response to narcissistic injury, and alternating states of idealization and devaluation. The narrow focus on the grandiosity of Narcissistic Personality Disorder may be contributing to low-prevalence rate and diagnosis in clinical practice. People that exhibit these vulnerable characteristics are more likely to seek help when they are in a vulnerable state. Without the vulnerable criteria as part of diagnosis, pathological narcissism may not be recognized by the therapist. This can be dangerous to the patient and possibly innocent people, with pathological narcissism being linked to suicide attempts, parasuicidal behavior, and homicidal ideation.
Another study was conducted to examine the content validity of the DSM-IV Narcissistic Personality Disorder and Borderline Personality Disorder criteria sets. (Blias, Hilsenroth, Castlebury, 1997) Outpatients meeting DSM-IV criteria for a personlity disorders were independently rated on all of the BPD and NPD symptom criteria for the DSM-IV. Reliable data was obtained for both presence and absence of a Personality Disorders, and symptom criteria for BPD and NPD. A three factor theory for the criteria was used for this study. The three factors for NPD were three core features found by the researchers, in the criteria for this disorder: Grandiosity, lack of empathy, and need for admiration. The results of this study, in my opinion, provide strong support for the content validity of the NPD criteria set. The study was conducted three times with three different groups of patients and therapists. In each study the same criteria for NPD were used in analyisis and diagnosis. The researches felt that if they were able to prove the validity of the criteria for NPD in each study. Repeating a study in this way and receiving the same data each time, adds to the validity of each study. Therefore, the researchers, feel that the NPD criteria set adequately covers the essential or defining features of the disorder. This conclusion is in contrast to the study I mentioned previously, which concluded that the criteria were to narrowly focused on the grandiose criteria for this disorder.
Narcissism has been in the DSM for over 30 years. The projected release of the revised DSM-V is May 2013. On the DSM-V website (http://www.dsm5.org) it doesn’t specifically state whether Narcissistic Personality Disorder will be removed from the DSM-V or not. Other Psychology websites say that Narcissistic Personality Disorder will remain in the DSM-V (Grohol, 2012). It seems as though opinions for the validity of NPD criteria vary, but each of the studies I examined mentioned the need for more research to better determine the effects it has on health and the most relevant and complete criteria. I am in accordance with this assessment. Whether or not the criteria are considered adequate, the impact that NPD has on health, therapists, psychologists, and patients diagnosed with NPD, is profound. From health concerns to diagnosis, this personality disorder is often un-diagnosed, under researched, and in need of a more complete understanding.