More and more attention is being paid to the term “narcissism” every year. In the age of immediate feedback, cell phones with cameras, social media and of course the “selfie”, people everywhere are wondering if we have become so preoccupied with ourselves that narcissism is on the rise
What IS narcissism?
Narcissism is short for Narcissistic Personality Disorder or NPD. This is a diagnostic category (in the Diagnostic and Statistical Manual known as the DSM-IV and V) that is characterized by grandiosity, need for admiration, exploiting others, and the tell tale sign–lack of empathy. It is not just another term for egocentric behavior- it is a significant personality disorder.
Narcissism occurs on a continuum of severity from “healthy” narcissism to malignant or psychopathic narcissist. The more serious narcissists tend to be men (75%) who are exceptionally self-absorbed, intolerant of others’ perspectives, insensitive to others’ needs, as well as unconcerned with the effect of their egocentric behavior on others. The DSM-IV-TR reports that the majority of narcissists (50-75%) are men. Narcissistic Personality Disorder (NPD) is characterized by dramatic, emotional behavior and is in the same diagnostic “cluster” as Antisocial and Borderline Personality Disorders.
NPD symptoms include:
- Believing that you’re better than others
- Fantasizing about power, success and attractiveness
- Exaggerating your achievements or talents
- Expecting constant praise and admiration
- Believing that you’re special and acting accordingly
- Failing to recognize other people’s emotions and feelings
- Expecting others to go along with your ideas and plans
- Taking advantage of others
- Expressing disdain for those you feel are inferior
- Being jealous of others
- Believing that others are jealous of you
- Trouble keeping healthy relationships
- Setting unrealistic goals
- Being easily hurt and rejected
- Having a fragile self-esteem
- Appearing as tough-minded or unemotional
There are nine DSM IV–TR diagnostic criteria for Narcissistic Personality Disorder. These include an exaggerated sense of self-importance; preoccupation with a sense of unlimited success; an unwavering belief that one is special and unique; requires disproportionate admiration for even minor accomplishments; expects automatic conformity with their beliefs; takes advantage of others; lacks empathy for others; is often jealous and exhibits egotistical beliefs and attitudes. Of the nine criteria, five or more need to be present for an individual to be diagnosed with NPD.
According to the DSM IV-TR, Narcissistic Personality Disorder is estimated to constitute less than one percent of the general population (.5-1%) and from 2 to 16 % of the clinical population. Of those diagnosed with Narcissistic Personality Disorder, 50 to 75 percent are estimated to be male and most often about 25% are female.
However, a more recent study published in the Journal of Clinical Psychiatry in 2008 (Stinson et al) puts the figure at a much higher rate. This study found that the prevalence of NPD was 6.2% in the general population. As expected, the rates were higher for males (7.7%) than for females (4.8%). This research looked at other variables as well and found that NPD was significantly more prevalent among Black men and women, Hispanic women, younger adults, and separated/divorced/widowed or never married adults. NPD was associated with mental disability among men but not women, supporting the notion that the more severe forms of NPD tend to be in males. This nationwide study in the United States demonstrated data that suggested Narcissistic Personality Disorder was more prevalent among younger adults and may support the idea that Narcissistic Personality Disorder is on the rise. It was hypothesized that this may be due to “social and economic conditions that support more extreme versions of self-focused individualism” (Bender, 2012).
In 2009, Twenge and Campbell conducted studies that supported the above figures. Their data suggested that the incidence of NPD had more than doubled in the U.S. in the prior 10 years, and that 1 in 16 of the general population had experienced NPD in their lifetime.
Prevalence of comorbidity
Narcissistic Personality Disorder (NPD) is often diagnosed in occurrence with other mental health disorders (“comorbidity”), especially with mood disorders, eating disorders, and substance-related disorders. Individuals with Narcissistic Personality Disorder are frequently abusive as well as prone to impulsive and reckless behaviors so it is not surprising that comorbidity of Narcissistic Personality Disorder (NPD) is high with other personality disorders such as the Histrionic, Borderline, Paranoid, and Antisocial Personality Disorders.
Narcissistic Personality Disorder (NPD) is often misdiagnosed as Bipolar Disorder (manic phase), Asperger’s Disorder, or Generalized Anxiety Disorder – and vice versa.
In the aforementioned 2008 Stinsen et al study, high co-occurrence rates were observed with substance abuse, mood and anxiety disorders, and other personality disorders. They reported, ”With additional comorbidity controlled for, associations with bipolar I disorder, PTSD, and schizotypal and borderline PDs remained significant, but weakened, among men and women. Similar associations were observed between NPD and specific phobia, generalized anxiety disorder, and bipolar II disorder among women; and alcohol abuse, alcohol dependence, drug dependence, and histrionic and obsessive-compulsive PDs among men. Dysthymia was significantly and negatively associated with NPD.”
“Fragile” narcissists appear to suffer the most: they had the poorest overall adaptive functioning and the highest comorbidity with major depressive disorder and generalized anxiety disorder. “Malignant” narcissists had the most problems with substance abuse and the most ‘externalizing behavior’ (e.g., spouse abuse). “High-functioning” narcissists had relatively good adaptive functioning and less psychiatric comorbidity.
J Clin Psychiatry. Jul 2008; 69(7): 1033–1045.