Narcissistic Personality Disorder
(10-5-04)

DSM-IV Mnemonic: Narcissistic Personality Disorder

SPE₃CIAL (Pinkofsky, 1997, p. 1198)

S [3] Special (believes he or she is special or unique)
P [2] Preoccupied with fantasies (of unlimited success, power, brilliance, beauty, or ideal love
E [8] Envious (of others, or believes others are envious of him/her)
E [5] Entitlement
E [4] Excessive admiration required
C [1] Conceited (grandiose sense of self importance)
I [6] Interpersonal exploitation
A [9] Arrogant (haughty)
L [7] Lacks empathy

 

Necessary and Exclusionary criteria (Benjamin & Strand, 1998; Benjamin, 1993)

necessary: "Grandiose sense of self importance; entitlement" (p. 783)

exclusionary: "Uncaring recklessness with self" (p. 784)

 

Ronningstam & Gunderson (1990) used a semi-structured Diagnostic Interview for Narcissism to assess 82 patients meeting following criteria: 1. 17-45 years of age; 2. capable of participation in diagnostic interview; 3. no known organic impairment; 4. official clinical diagnoses in one of three categories:

a. Narcissistic personality disorder (n=24): a prototypic sample which excluded patients with complicating Axis I diagnosis (major depression or concurrent substance abuse). Used LEAD (Longitudinal/Expert/All Data) standard (Spitzer, 1983).

b. Other "dramatic" cluster personality disorder (n=36)--borderline (Diagnostic Interview for Borderline Patients) & antisocial (SCID-II). Near-neighbor diagnoses increase specificity for disorder rather than features that are just prevalent (highly sensitive). For instance, in this study were aggressive, exploitive, & envious (Kernberg) but these features did not discriminate. Also they were hypersensitive, showed intense reactions to criticisms, and idealized/devalued others (Kohut); but these did not discriminate.

c. Other psychiatric disorders (n=22)
"The most outstanding features of the patients with narcissistic personality disorder was their grandiosity (i.e. belief in their uniqueness and superiority, combined with an unrealistic overvaluation of their own abilities, and grandiose fantasies)" Ronningstam & Gunderson, 1990, p.921). Nine characteristics best discriminated:

1. Superiority: sustained unrealistic view self as better than others; viewing others as different from self & inferior; disdain for others.

2. Uniqueness: sense of self as unique; belief that few have much in common with oneself; often feel misunderstood.

3. Exaggeration of talents: even though generally capable, exaggerate aptitudes or achievements in unrealistic ways.

4. Boastful or pretentious behavior: brag and behave ostentatiously; assume interest and naivete of others

5. Grandiose fantasies: fantasies of unlimited success, power, beauty, wealth, or ideal love occupy

6. Self-centered and self-referential behavior: observably self-preoccupied, and prone to assign personal meanings to events (personalize) independent & unrelated to them; lack of interest in opinions and reactions of others

7. Need for attention and admiration: consider admiring attention from other important, report working hard to get it; do not believe they have unrealistic expectations about getting attention and admiration.

8. Arrogant and haughty behavior: snobbish, supercilious, patronizing behavior in relation to others

9. High achievement: often have sustained periods of successful academic, employment, or creative achievement. Used as justification for their sense of superiority. Also a reason they are more apt to be seen in private practice than in clinics. Not useful as criterion for pathological narcissism, but does help demographic differentiation.