How is a narcissistic psychopath

Narcissistic Personality Disorder

Personality traits as a disturbing burden (page 11/16)

Characteristics of narcissistic disorders

This section provides a concise summary of all the important information about Narcissistic Personality Disorder.

A classification of narcissistic personality disorder in the overall concept of narcissism as well as further information on characteristics, causes, manifestations, degrees of severity and treatment options of narcissism as well as the origin of the term can be found in the article narcissism.

Colloquially, a “narcissist” is a person who shows pronounced egoism, arrogance and selfishness and who is inconsiderate towards others.

Narcissistic personality disorder, on the other hand, is a pervasive personality disorder in which there is a lack of self-esteem and a strong sensitivity to criticism. These characteristics alternate with a conspicuous self-admiration and exaggerated vanity and an exaggerated self-confidence outwardly. The latter helps those affected to compensate for their low self-esteem. In addition, they can badly empathize with other people.

Those affected tend to present themselves to the outside world as great. For example, they emphasize their professional achievements, appear very status-conscious or have a tendency to exclusive activities. Often they overestimate their own abilities or present them better than they really are. In addition, they tend to lie - with the aim of getting attention and recognition or of getting their own way. Because of their lack of empathy, they often behave towards others in a way that they would not want to be treated themselves: they exploit others or destroy their achievements out of envy.

Michael was convinced that he was a special person: he considered himself intelligent and good-looking and someone who achieved outstanding professional performance, had a large circle of friends and acquaintances and always had an intense relationship with an attractive woman. Even as a child and teenager, he had believed that he was actually entitled to more than he was getting.

When he was offered a job as editor of a newspaper, he applied with the words: “I am extremely talented. I am sure that I will achieve great things in this position and that I will shortly create a new standard in this region. ”In his new job he did well - but not as outstanding as he himself believed. In addition, after a short time he was extremely unpopular with his colleagues and employees. They thought he was arrogant, conceited, and self-centered. He often bragged about grandiose plans, manipulated others, had choleric outbursts and refused to take responsibility when things went wrong. If someone criticized him only lightly, he would get angry and be convinced that the others would only be jealous of him.

At first glance, Michael was charming and socially successful. But he only used his charm to benefit from other people. His relationships were also superficial: he often had enough of his partners after a short time, then treated them dismissively and broke up quite callously. He himself wasn't sad about the breakups - and other people meant nothing to him either, except when they were useful for his goals. (after Comer, 2008)

Symptoms and frequency of narcissistic personality disorder

Those affected have according to DSM an exaggerated notion of how important they are themselves. They challenge and expect to be constantly admired and praised by others. At the same time, they can only take other people's perspectives to a limited extent. The disorder begins in adolescence or early adulthood. At least five of the following criteria must be met:

  1. Those affected have a terrific understanding of their own importance. For example, they exaggerate their achievements and talents or, if they do not do so, expect to be recognized as superior by others.
  2. You are very engrossed in fantasies of limitless success, power, brilliance, beauty, or ideal love.
  3. They believe that they are “special” and unique. That is why they are convinced that they can only be understood by other “special” or high-ranking people or that they only have to maintain contact with them.
  4. You need excessive admiration.
  5. You have high expectations. This means that they have an exaggerated expectation that expectations will be automatically met or that they will be treated particularly favorably.
  6. They are exploitative in interpersonal relationships, that is, they take advantage of others to achieve their own goals.
  7. They show a lack of empathy, that is, they are unwilling to recognize, accept, or empathize with the feelings or needs of others.
  8. They are often jealous of others or think others are jealous of them.
  9. They display arrogant, haughty behaviors or views.

In contrast to the DSM, the Narcissistic Personality Disorder is in the ICD-10 only listed under “other specific personality disorders”, but not described in more detail there.

Read more about the three types of narcissism here.

How common is narcissistic personality disorder? What other diseases often occur at the same time?

Probably less than one percent of the population is affected by the disorder. 75 percent are men and 25 percent women. The disorder is often seen along with borderline personality disorder.

You can find more information about the comorbidities here.

Causes of Narcissistic Personality Disorder

In this disorder, too, it is assumed that biological, psychological and environmental factors interact. It is believed that genetic factors play a role in its development. In addition, the disorder can be promoted by the fact that the parents show their child little appreciation, are not empathetic and possibly overwhelm them. In order to still get recognition, those affected then develop a behavior in which they constantly emphasize their own abilities and present themselves particularly well to the outside world.

Psychoanalytic theory assumes that people with narcissistic personality disorder did not receive enough love and recognition from their parents in their childhood. Or it could be that the parents put their child and their desires at the center and admired them excessively for their talents.

Those affected constantly fluctuate between an overly positive self-image and the fear of not meeting the demands of others. They are convinced that they will only be loved if they do a lot for it and constantly show their talents and specialties, and they constantly need confirmation from others.

From the perspective of psychoanalysis, the constant feelings of envy and the lack of empathy can be explained by the fact that those affected have an unconscious anger towards others. Their tendency to take advantage of and manipulate others also prevents them from developing satisfactory interpersonal relationships.

Cognitive behavioral therapy assumes that those affected were treated too positively in their first years of life - they were, for example, idolized, admired or idealized by their parents. As a result, they develop the self-image that they are special and overestimate their own abilities.

Narcissism test

Treatment of Narcissistic Personality Disorders

Narcissistic personality disorder is primarily treated with psychotherapy. However, those affected rarely come into therapy on their own. The reasons for therapy are usually other mental disorders, especially depression.

Possible problems in psychotherapy and possible solutions

Because those affected see themselves as something special and are reluctant to question this image, the disorder is considered to be relatively difficult to treat. In therapy it is therefore helpful to understand this perspective as a kind of self-protection that at least ostensibly gives the patient a sense of self-worth and protects them from psychological crises.

Another problem in therapy is often that those affected believe that they are entitled to a very special treatment. In addition, they tend to admire and idealize the therapist on the one hand, but then react again with feelings of envy or devaluation. It is also characteristic that they try to manipulate the therapist into certain behavior. It is therefore important to recognize the central personal needs of patients and to respond to them - but also to establish clear rules and set limits.

Psychoanalytic and deep psychology-based therapy

In the context of psychoanalytic therapy, different approaches for the treatment of a narcissistic personality disorder have been developed. The transference-focused psychotherapy according to Otto Kernberg and John Clarkin assumes that interpretations should be used in therapy and that patients should be confronted with the fact that their overestimation of themselves is a defense mechanism against anger, aggression and feelings of envy. In practice, however, it has been shown that this procedure often leads to premature discontinuation of therapy.

Other psychoanalysts such as Heinz Kohut also regard a confrontational approach as making little sense because it only leads to defensive reactions on the part of the patient. Instead, Kohut and his successors see a supportive, sensitive and caring approach as much more appropriate. They emphasize that the therapist should treat those affected with respect and empathy even if they either extremely idealize or devalue them. In this way, the patient can experience that he is accepted and valued as a person and gradually develop a more positive self-image that does not depend on the constant admiration of others.

Cognitive behavioral therapy

Here, too, building a sustainable, appreciative therapeutic relationship is an essential element of therapy. The patient's peculiarities should not be judged morally. Instead, very specific experiences and problems are dealt with. They can be used to work out the patient's characteristic difficulties in relationships and gradually change them.

In addition, attempts are made to change unfavorable thought patterns - for example the idea of ​​constantly having to be good in order to be accepted and valued by others. Patients can learn to no longer base their self-esteem so strongly on the opinion of other people and to deal better with criticism. The patient's black-and-white thinking (i.e. the tendency to view themselves or others as grandiose at times, but then again as worthless) is questioned and gradually replaced by a more gradual perspective.

So that those affected develop more empathy, role plays with video feedback can be used. Here they can experience how their own behavior affects others and then change it accordingly.

Read more about treating narcissism here.

Therapy with psychotropic drugs

Typically, psychiatric drugs are not considered helpful in narcissistic personality disorder. They are mainly used when other mental disorders are present at the same time, for example depression.

The narcissistic personality style according to Kuhl & Kazén

People with a narcissistic personality style - which is similar to a narcissistic personality disorder, but less pronounced - value the special. For example, you are particularly performance-oriented, prefer unusual clothing and display a status-conscious demeanor. They are often ambitious and have high expectations. However, this can also lead to them being quickly offended or jealous of others.

Read more about the characteristics of narcissistic personality traits here.