narcissistic personality disorder

Introduction

A syndrome of grandiosity, need for admiration, lack of empathy.

Epidemiology

• generally begins in early adulthood

Clinical manifestations

• pervasive sense of entitlement, grandiosity & arrogance
• lack of empathy
• disturbances in emotionality, cognition, interpersonal functioning, & impulse control that cause significant distress or impaired functioning
• patients tend to exaggerate achievements & seek admiration
• elderly: may become hostile, paranoid or depressed

Diagnostic criteria

requires 5 or more of the following)

• grandiose sense of self-importance
  • exaggerates achievements & talents
  • expects to be recognized as superior without commensurate achievements
• preoccupation with fantasies of limited success
• belief that he/she is special & unique & can only be understood by, or should associate with, other special or high-status people (or institutions)
• needs excessive admiration
• has a sense of entitlement
  • unreasonable expectations of
    • favorable treatment
    • compliance with his/her expectations
• interpersonally exploitive: takes advantage of others to achieve his/her own ends
• lacks empathy: unwilling to recognize the feelings & need of others
• often envious of others or believes that others are envious of him/her
• arrogant

Differential diagnosis

• histrionic personality disorder
  • no inflated sense of self-importance or entitlement

Management

• assess for & treat mood lability, depression, anxiety, substance abuse
• consistent, structured approach with well-defined boundaries to contain unacceptable behaviors
• team approach with a common plan (teamwork)
• behavioral contracts to address recurrent unacceptable behaviors
• resort to higher level of care if management ineffective
• do not personalize aggressive behavior directed towards staff
  • allow staff opportunities to vent

More general terms

• cluster B personality disorder

Additional terms

• narcissism