The DSM 5 is the psychiatrist’s “bible” used to describe and diagnose disorders. Disorders are separated into numerous categories of illnesses such as depression, anxiety, though disorders, and personality disorders. There are three groups of personality disorders. Over the next few blogs I will be discussing a variety of personality disorders that counselors may see. Today I want to discuss Narcissistic personality disorder. Like all personality disorders, someone with Narcissistic personality disorder will have demonstrated the traits by adolescence, or early adulthood. These traits are not considered Narcissistic personality disorder if they are caused by a physical disorder such as an illness or brain injury. The traits are present in all areas of their lives including at home, work, with friends. They are an ingrained part of who the person is, and not easily changeable.

Treating people with Narcissistic personality disorder is difficult because they think it’s everybody else, and are unaware that they cause their own problems. Typically, they won’t come into counseling unless forced to do so by a partner who is about to leave, or through a court order due to legal problems. The narcissist builds up his self-esteem by putting down others. He is grandiose and sees himself as great, awesome, amazing, terrific, and in every way, better than others. He can’t tolerate losing. If someone beats him in a game, they cheated. If someone gets a job that he wanted, he sees it as unfair, dishonest or rigged. He will react with excess anger and even threats to anyone who gets what he considers his “God-given” right. If it was in his power, he would jail or even suggest killing anyone who he saw as standing in his way of getting what he wants and thus feels he deserves. The narcissist needs to be the center of attention at all time. He will interrupt and try to prevent others from having any time in the lime-light. He always needs things to be about him and can’t stand anything that is not about him. He may seem to have excessive self-worth, but underneath, he may have an inferiority complex. He cannot tolerate any disapproval or criticism and has no self-awareness or insight into his own behaviors. The narcissist has difficulty with empathy and interpersonal relationships. He (most narcissists are men) may have never been married, or have had multiple failed relationships or marriages. He has no problem cheating in his relationship, as he sees it as his right and believes that he is highly desirable to the other sex. He has no insight into the other person’s feelings. He is not attuned to others reactions to him, and overestimates his desirability. If someone rejects him, he may respond with anger and extreme upset. The narcissist’s relationships are shallow and self-serving. He is not honestly concerned about his partner’s feelings.

Narcissists that I have worked with generally come into counseling due to court ordered legal problems, often domestic violence, drug abuse, or rape. To summarize, narcissists tend to be superficially charming, attention seeking, many are highly sexual, and grandiose. They may reach for the stars but then react with anger or even violence when they learn their goals are out of their reach, or someone else gets what they want. Their lack of insight and feeling of being privileged can be hurtful to others, and even dangerous if they are in a position where they can use their anger against others. Dangerous dictators such as Hitler, Stalin and Pot Poi often demonstrated the short temper, grandiosity and uncaring that are classic of both sociopaths and narcissists.

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