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.