Narcissistic Personality Disorder
DSM-5 and Narcissistic Personality Disorder
The DSM-5 will better describe the complete character of narcissistic personality disorder (NPD) as more features are recently becoming further understood. For instance, it is known that persons with narcissistic personality disorder are aggressive and boastful, who blame others for their own setbacks and exaggerate their own performances; however, this is only a small sense of who they really are. Their complexity reaches further down. Individuals with NPD often have several interpersonal problems and comorbid disorders in addition to their core disorder.1 It is not uncommon for these individuals to be diagnosed with depression, bipolar disorder, substance use disorders, eating disorders, and be at an increased risk of suicide. As the individual ages, their mood disorders may worsen as there is much dissatisfaction with their personal and professional lives.2 According to the article “Narcissistic Personality Disorder: Rethinking What We Know” by Psychiatrist and Psychotherapist at the Center for Metacognitive Interpersonal Therapy in Rome, Giancarlo Dimaggio, M.D., individuals with NPD often have shallow romantic relationships and work conflicts.1
It is misunderstood that feelings of grandiosity and fantasies regarding power and success are core characteristics of a person with NPD.1 The DSM-5 prototype states that self-appraisal may fluctuate from hypervalued to self-derogation, along with their feelings of self-esteem.1 According to Dimaggio, anger is often triggered by feelings of social rejection as individuals with NPD feel the need to humiliate those who criticize them.1 They set their goals at levels almost too high to reach and oftentimes blame others for their failure.1 However, when they are unable to deny their weaknesses, they become extremely depressed and the risk of suicide increases.1
How does narcissistic personality disorder develop?
Researchers are unable to agree on one specific reason for the development of NPD; however, a couple theories are widely agreed upon.1 First, some believe that lack of parental empathy during a child’s developmental stages are a reason for the development of NPD.1 As parents may fail to appropriately recognize and regulate their child’s emotions, the child will then be left with intense feelings that do not receive any recognition or response, leading to affect dysregulation. Attachment then becomes an issue as the child’s basic needs are unmet, translating into an adult striving for attention and admiration.1 Second, if a child is raised in a family where status and success is of the utmost importance, with no tolerance for anything less, the overt grandiosity an individual shows is a reaction to the humiliation experienced due to failure during their upbringing.1 Therefore, grandiosity is used to avoid subjection to further criticism and humiliation.1 Tracy and colleagues state that parenting styles such as lack of supervision, corporal punishment, authoritarian parenting, and mixture of praise and coldness also predict the development of NPD.
The Characteristics of a Person With Narcissistic Personality Disorder
Individuals with NPD have a need to maintain a strong sense of self-worth and personal goals that are of value.1 Perfectionism is a common train among persons with NPD.1 After an accomplishment is met, they often raise their goals even higher, which eventually results in continued dissatisfaction. Their standards of perfectionism are also set for others, who they often criticize when failure occurs.1 Persons with NPD often blame others for their failure, withdraw from intimate relationships, and are seen as controlling and domineering.1
According to Dimaggio, empathy dysfunction is a central characteristic of NPD.1 Persons with NPD are often able to understand how someone is feeling but are unable to appropriately respond.1 In fact, they often think they are being empathetic when, in truth, they are not.1 An MRI study showed that persons with NPD displayed decreased activation in the right anterior insula during an empathetic task. Participants were unaware of their impairment as well as their own emotions, showing that reduced empathy is in fact part of a larger impairment, including poor self-awareness. Dimaggio states that this is likely due to their inadequate parenting, where caregivers were unable to recognize and regulate their affects.1
In conclusion, Dimaggio states that more research is needed regarding NPD, a diagnosis that has been understudied for decades, despite its commonality.
 Dimaggio, G. (2012, July 18). Narcissistic Personality Disorder: Rethinking What We Know. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/display/article/10168/2091235
 Ronningstam E. Narcissism personality disorder: facing DSM-V. Psychiatr Ann. 2009;39:111-121.
 Fonagy P, Gergely G, Jurist EL, Target M. Affect Regulation, Mentalization, and the Development of the Self. New York: Other Press, 2002.
 Tracy JL, Cheng JT, Martens JP, Robins RW. The emotional dynamics of narcissism: Inflated by pride, deflated by shame. In: Campbell WK, Miller JD, eds. Handbook of Narcissism and Narcissistic Personality Disorder: Theoretical Approaches, Empirical Findings, and Treatments.Hoboken, NJ: John Wiley & Sons; 2011:330-343.
 Dimaggio G, Semerari A, Carcione A, et al. Psychotherapy of Personality Disorders. London: Routledge; 2007.
 Fan Y, Wonneberger C, Enzi B, et al. The narcissistic self and its psychological and neuralcorrelates: an exploratory fMRI study. Psychol Med. 2011;41:1641-1650.
 Dimaggio G, Lysaker PH, eds. Metacognition and Severe Adult Mental Disorders: From Basic Research to Treatment. London: Routledge; 2010. Narcissistic.