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Narcissistic Personality Disorder Disappearance from the DSM

I have heard or read several theories of why someone becomes a narcissist.  The classic theory is that the narcissist had a disrupted relationship with a caregiver, abuse, over praise, under praise, special talents or beauty that set them apart.  My opinion is that it runs in familes and their is a strong genetic component.  My guess is that in the next years with genetic testing and brain imaging that these disorders will prove to have a strong hereditary basis.  I have also read that the narcissists are subconsciously trying to over compensate for a deep sense of being flawed.  The general stereotype is the beautiful women or man, like Warren Beaty or artists of various sorts. Just because someone might have this personality, doesn't mean they can't be excellent workers or of good moral character.  

My observation is that they come in all shapes and sizes of varying looks and talents and someone is just as likely to be a narcissistic school teacher as in the arts.  Overall men tend to take on the more antisocial traits of personality disorders and women tend to take on the more hystrionic traits.   My thought is that if you have asked yourself if you are a narcissist, your not.  If you haven't asked yourself this, you might be and probally don't care anyway.  I find them not able to be self reflective and empathetic, that is necessary for most relationships.  When I think about how to describe interacting with a narcissist I think of the lyric, "walking the wire inbetween pain and desire and looking for love inbetween."

The  words that describe this type of personality, in my mind are entitled, grandiose and  paranoid and lack of empathy.  Often times believing that they deserve special treatment and are often trying to go around the system in various ways.  Grandiose as they exagerate their talents or create kind of fantasy scenarios, in which they expect others to participate.  Paranoid, often believe that others are jealous of them and mean to do them some form of  harm. A total lack of ability to take other peoples feelings into consideration.  This can be charasmatic and also very painful for people.  They are facinating to watch from afar yet incredibly difficult for the people that love them or have to be around them for work. That is if they can maintain long term relatonships and work. 

Often they have a pattern of disrupted relationships and often do not work or play well with others.  If they are also capable of being employed, such as doctor or opera singer, cashier, accountant, they are often seen as difficult to work with.  When they end up in groups they often have great favorites and split the staff by this and other behavior.  Also they seem to garner a base of strong supporters, so even when there is an agreement that a certain personality is disruptive, a small faction will continue to support them no matter what.  That is part of the splitting.  Both in families and  at work.

At first I was surprised that the personality of narcissim was removed from this edition of the DSM.  I had read an article about it in the New York Times about it being removed this year.  At first I thought how in the heck are you going to be able to identify these people?  Also Aspergers syndrome has been removed from the DSM this edition.  For example now people with Aspergers will be given a level, on a gradient, and with symptom based Austism spectrum disorder. Also as much as 98 percent of Autism shows symptoms on an MRI scan.  The move overall is now toward more spectrum diagnosis rather than labeling.  I see the logic in this if one thinks about it. 

For intance, to be honest insurance companies have not paid for treatment for personality disorders for 25 years.  Also, if the diagnosis of personality disorder is given, it was almost always a secondary diagnosis.  Than, the reality of someone actually gaining any insight or change in their behavior with therapy or medication is basically zero.  So, insurance won't pay for it, it's basically untreatable, I can see the logic in going to more symptom focused diagnosis on a spectrum.  That way you could for instance work on behaviors that might cause less trouble at work etc.

The DSM is an acronym for Diagnostic Statistics Manual for mental disorders.  The new one coming out this year without the Narcissistic Personality Disorder for the first time, is the fifth edition, I think, the DSM V.  This manual is widely used by the medical and insurance profession for diagnosis and payment of treatment.  There are several levels of diagnosis.  An Axis I common diagnsis would be major depression.  An Axis II common diagnosis would be a personality disorder.  People are often not given Axis II diagnosis, it is often left blank.  What we used to chart when I was an ER nurse doing psychiatric exams was kind of a subjective charting code.  We used to say that the person was only cooperative if their needs were immediately and promptly met.  

What the DSM doesn't do are include treatment guidelines.  I would love to see an addendum book, describing generalized treatment pathways.  One so anyone can understand how limited treatment options are, and two so that the treatment for the families of these people could be mentioned.  For with every narcissist is a very stressed family or co-workers. I have been told that if there are not any active substance abuse or other addiction issues etc. or these are treated, the narcissist could potentially be receptive to therapy.  In some cases if the personality is very motivated to maintain a job or marriage they can be enticed into therapy, that could change some basic behaviors.  The reality is that even in psychiatric treatment little can be done to augment the personality.  

For your garden variety neurotic there is hope!  Therapy and antidepressants work marvels for this group.  Also mental  illnesses are effectively treated with medication and being under a doctors supervision.  Personality disorders, eh, don't hold your breath.   

To me narcissim has absolutely nothing to do with self preservation or talking about ourselves. That is fairly normal behavior. It is a pattern of lack of empathy.  For example I had a conversation with a narcissist the other day by telephone.  Within several minutes she had said some terrible things in a tongue in cheek manner, that were to her fantastically humorful and witty, and to me were just horrible and hurtful.

Narcissists can be incredibly charming and attactive.  There is definately an allure about being so sure of youself.  I think all of us have fallen under the spell of someone with a personality like this.  There is a certain comfort in it as well. As one can give themselves to the narcissist so fully, kind of tag along on their shooting star stream.  I did read a heartening piece that many children of narcissistc parents often grow up to be excellent parents themselves.  When one has a narcissistic person in their lives in whatever capacity, its like constantly picking up shattered glass bits.  Always trying to piece things back together. 

Another optimistic book I read in the past about this topic was by a writer called Scott Peck.  He wrote a marvelous book called "People of the Lie", about narcissism and recovery from being in contact with narcissim.   Although the personality disorder of Narcissistic Personality Disorder has been removed from the DSM V this year and the trend is to go toward more spectrum based on symptoms, for me in regular contact with a narcissist relative, its a lot to handle.  Also, me having oberved these things over the years has made me particularily atuned to both the people who have experienced this type of relationship and also the people with the traits.   In my opinion some obvious narccissists to me might be Tatum O'Neil or even George Bush.  Some narcissists just are shallow and generally not reflective, and yes there are really bad ones and not so bad ones.

In my observations some characteristics of Narcissistic Personality Disorder are lauded in the media and society.  So we have these pretend narcissists trying to be theatrical fabulous people.  Basically narcissistic wannabees.  So you can also feign these traits in order to garner attention.  I think most of us know the difference between a little theatrical posturing to gain attention in certain circumstances and the real thing.  Entertaining people is also beautiful and not always just attention seeking.  Anyhoo, thats just about all I can talk it for now other than describing examples. My humorous side refers to my personal spoof on  that Willie Nelson song "to all the narcissists I have loved before".  I don't think Willie Nelson is a narcissist.  

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Living with a narcissit

From my work with mothers who try to protect their children in court, I've learned that many times abusive men fall under the description of narcissists. Lacking empathy, self-absorbed, violent, irrationally demanding, they are emotionally if not physically and sexually abusive to their wifes/girlfriends and children.

I've had a different experience with a much younger sister who is narcissistic. She talks obsessively non-stop--and the topic is herself and her interests. (I once joined her in an exercise class and she didn't stop chattering, cracking jokes, complaining about aches, describing her medical history, or running a commentary about the exercise routine--in total disregard to the fact that she was interrupting the class.) She does not have the attributes of exceptional beauty, although she is attractive, nor of one outstanding talent other than an extremely high IQ. There hadn't been any interruption in her relationship with our mother; in fact, my sister was like that when she was a baby, but then one would expect a child to be self-centered. However, she spoke in complete sentences at 10 months old, and attended university math classes at 10 years old.
She is married for many years (to a husband that doesn't speak) and has 3 children who are very bright, though "normal." She's never worked or attempted to use her exceptional abilities, even in years that her husband was out of work and later as they continue to struggle economically. Her days pass as if she is in a summer camp--playing computer games, doing arts and crafts--having long depleted her sons' university funds set up by the grandparents....
I am not sure how that personality falls under the symptons without a lable.

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garden variety neurotic

My overall concern is that ones normal self absorbtion is not classified as narcissism. True blue narcissists have a tremendous difficulty maintaining long term relationships. Also flirt with run ins with the law OR various forms of institutionalization and have great difficulty holding down jobs, of one job which is considered homemaker.  Being bad with money is terribly regrettable but not necessarily a symptom of mental illness.  Since a lot of people have money troubles without mental illness.   I agree your sister hangs on the fringe of possibly family inherited borderline traits and what you describe must be sickening to witness. She seems to have made a choice somewhere along the way not to take it all the way. AND YES YOU CAN BE BORN with a personality disorder unfortunately!    I notice a lot of narcissm seems to couple with other addictions, not always but often. Once the other addictions are treated a clearer picture can be seen. My guess is that there is more going on that just narcissistic personality disorder as being a stable homemaker and bad with money is not a crime. Sometimes untreated OTHER TROUBLES addictions, depressions,  have narcissistic qualities. Please google the NYT's article on narcissitic personality disorder being omitted from the next edition of the DSM. In the article is a great example of narcissim. I appreciate your comments very much.  For me education is expensive and anything after a bachelors is overrated and expensive unless you have special chances at your school or your family can pay for it or something.  To me talking too much during an exercise class is pretty low key stuff.

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Folks in love with their mirror....

I grew up in a household full of narcissists—real ones. One point you missed is that in such an environment, there must always be someone who is not allowed to enjoy a private fantasy. Please don’t invent “Cinderella syndrome.” *c r i n g e *

As far as diagnosis and treatment is concerned, I question both. Personality disorders are basically self indulgence, and giving one such as narcissism a clinical name seems to me to be playing into the "disorder." Drug dependencies by any other name remain drug dependencies, and do little to encourage self improvement.

Put the predators down, refuse to participate in the fantasy worlds, get on with you life and force those left out to get on with their own lives, or die of loneliness. Yeah, it’s cruel, but real. It kept society going for ages. Not nearly enough reality these days, and way too much fantasy posing as real, such as "reality television," which, by the way, encourages narcissism.

We are four or five generations deep into a culture that looks to visual media for role models—preening actors, largely without empathy, posing for the rubes. I grew up surrounded by wannabe Garry Coopers and the like. So on the one hand we encourage the behavior and then on the other we identify those who best emulate it as having a personality disorder. What a losing paradox.

For some unfathomable reason we tend to focus on preserving the worst of society at the expense of the rest, even if we put them in cages after scolding doesn’t work. That's down right illogical, anti evolutionary, and a bit daft. Where in nature do you find that? And please don’t tell me that as a species we are above nature, as the evidence will not support such a claim.


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supporting the regular folk

My overall goal in writing a quasi sympathetic blog about narcissism is that I don' want our neurotic bretheren to suffer. As writers we tend to be self focused and worry warts; and I do NOT consider substance abuse to be part of a personality disorder. Sober people often act a lot better and things even out. If someone is still acting with lack of empathy and in a grandiose fashion after being sober, why thats a full blown cluster B.

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MY point was giving drugs to

MY point was giving drugs to cure personality disorders may serve to create more problems than they cure, as in drug depencies.

And which is worse--our neurotic brethern's suffering, or the suffering they chronically engender in others?

Better to laugh at narcissists, embarass them into behaving or send them packing. Sometimes it is the only way to get through to them.

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Neurotic and Narcissism are two different characters

Neurotic is not narcissistic. Google it. and if you get the chance read the NYTs article, its okay not life altering or anything.

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Neurotic and Narcissism are two different characters--no shit?

“My overall goal in writing a quasi sympathetic blog about narcissism is that I don' want our neurotic bretheren to suffer” was you observation, not mine. I just answered you. Trust me, I really don’t need to google the term to understand it, thank you very much.

I think you miss the big picture, which in my opinion is that with rampant overpopulation, more and more folks need to “stay busy” And lots of folks with smarts, especially left brained smarts, do it through the “professions.” And given the nature of what passes for education, more and more folks write more and more long winded papers signifying little.

In psychology, it tends toward rehash, as in renaming manic depression bipolar disorder; or pithy observations cloaked in psycho babble, creating terms like my personal favorite, “passive aggressive” that go in and out of favor; or simply reinventing stereotypes, such as your narcissists.

Narcissism is a genuinely offensive state of being for everyone save those dominant personalities who champion it, and, as you so astutely observed, those wretched needy folks who are drawn to them like moths to a flame.

But a personality disorder? How many world leaders are narcissists? In fact, how many leaders period are narcissists? What would human history be without them? It’s usually the folks that think way too highly of themselves that push the political envelope, that conquer empires, that peddle new religions, that bask in the limelight overlong demanding adoration, obedience and emulation, that coin the memes that keep other folks chatting endlessly about nothing.

It was the ancient Greeks who made all those nifty psychological observations we have so recently reinvented in the name of psychology, enshrining the various personality anomalies in myth allowing folks to spot the major forms of self indulgent behavior. Read your mythology. Forget psychology.

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I agree that they are disagreeable people and better left to the wayside. I wanted to say that being neurotic and normally depressed or worried is very treatable and common. And I wanted to add that a lot of people are just awful without a single pathological personality disorder. I agree that labels are used to readily. I already find you interesting Paul. I have little interest in arguing. I was motivated to write out of having my own experience with being slimed by this type of personality. Also, seeing it kill people over time.

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narcissism verses antisocial personality disorder

re-reading this blog I wrote I think many people confuse narcissism or severe self absorbtion and inability to have meaningful relationships, to the more severe and disturbing anti-social personality disorder. although many criminals have all the personality disorder traits, one does not need to be narcissistic to be criminal, yet one is definitely suffering an anti-social personality disorder when they commit most sexual or violent crimes. Definately narcissism does not equal criminal behavior. yes, antisocial behavior does equal criminal behavior. what i find very very important is that all personality disorders kind of come into one big group of difficulty having long term relationships. at least the narcissists keep up jobs in some cases. the real trouble is when they cant work or have a relationship because this leads to being a burden on society either by crime or dependence. that is when the personality disorder is a burden on society.