Narcissistic personality disorder — one of several types of personality disorders — is a mental condition in which people have an inflated sense of their own importance, a deep need for excessive attention and admiration, troubled relationships, and a lack of empathy for others. But behind this mask of extreme confidence lies a fragile self-esteem that’s vulnerable to the slightest criticism.
A narcissistic personality disorder causes problems in many areas of life, such as relationships, work, school or financial affairs. People with narcissistic personality disorder may be generally unhappy and disappointed when they’re not given the special favors or admiration they believe they deserve. They may find their relationships unfulfilling, and others may not enjoy being around them.
Treatment for narcissistic personality disorder centers around talk therapy (psychotherapy).
Signs and symptoms of narcissistic personality disorder and the severity of symptoms vary. People with the disorder can:
- Have an exaggerated sense of self-importance
- Have a sense of entitlement and require constant, excessive admiration
- Expect to be recognized as superior even without achievements that warrant it
- Exaggerate achievements and talents
- Be preoccupied with fantasies about success, power, brilliance, beauty or the perfect mate
- Believe they are superior and can only associate with equally special people
- Monopolize conversations and belittle or look down on people they perceive as inferior
- Expect special favors and unquestioning compliance with their expectations
- Take advantage of others to get what they want
- Have an inability or unwillingness to recognize the needs and feelings of others
- Be envious of others and believe others envy them
- Behave in an arrogant or haughty manner, coming across as conceited, boastful and pretentious
- Insist on having the best of everything — for instance, the best car or office
At the same time, people with narcissistic personality disorder have trouble handling anything they perceive as criticism, and they can:
- Become impatient or angry when they don’t receive special treatment
- Have significant interpersonal problems and easily feel slighted
- React with rage or contempt and try to belittle the other person to make themselves appear superior
- Have difficulty regulating emotions and behavior
- Experience major problems dealing with stress and adapting to change
- Feel depressed and moody because they fall short of perfection
- Have secret feelings of insecurity, shame, vulnerability and humiliation
When to see a doctor
People with narcissistic personality disorder may not want to think that anything could be wrong, so they may be unlikely to seek treatment. If they do seek treatment, it’s more likely to be for symptoms of depression, drug or alcohol use, or another mental health problem. But perceived insults to self-esteem may make it difficult to accept and follow through with treatment.
If you recognize aspects of your personality that are common to narcissistic personality disorder or you’re feeling overwhelmed by sadness, consider reaching out to a trusted doctor or mental health provider. Getting the right treatment can help make your life more rewarding and enjoyable.
It’s not known what causes narcissistic personality disorder. As with personality development and with other mental health disorders, the cause of narcissistic personality disorder is likely complex. Narcissistic personality disorder may be linked to:
- Environment ― mismatches in parent-child relationships with either excessive adoration or excessive criticism that is poorly attuned to the child’s experience
- Genetics ― inherited characteristics
- Neurobiology — the connection between the brain and behavior and thinking
Narcissistic personality disorder affects more males than females, and it often begins in the teens or early adulthood. Keep in mind that, although some children may show traits of narcissism, this may simply be typical of their age and doesn’t mean they’ll go on to develop narcissistic personality disorder.
Although the cause of narcissistic personality disorder isn’t known, some researchers think that in biologically vulnerable children, parenting styles that are overprotective or neglectful may have an impact. Genetics and neurobiology also may play a role in development of narcissistic personality disorder.
Complications of narcissistic personality disorder, and other conditions that can occur along with it, can include:
- Relationship difficulties
- Problems at work or school
- Depression and anxiety
- Physical health problems
- Drug or alcohol misuse
- Suicidal thoughts or behavior
Because the cause of narcissistic personality disorder is unknown, there’s no known way to prevent the condition. However, it may help to:
- Get treatment as soon as possible for childhood mental health problems
- Participate in family therapy to learn healthy ways to communicate or to cope with conflicts or emotional distress
- Attend parenting classes and seek guidance from therapists or social workers if needed
Dr. Brandy Lee: My name is Dr. Bandy Lee. I’m a forensic psychiatrist at Yale School of Medicine. A forensic psychiatrist does evaluations for the courts and testifies before legal or governmental bodies. My views are my own, although I do represent the World Mental Health Coalition as its president.
My colleagues and I assessed Special Counsel Robert Mueller’s report from a mental health perspective.
Our assessment is definitive.
Our recommendations were, first and foremost, to remove Mr. Trump from access to nuclear weapons and war-making powers.
We could offer many more, but given the urgency, we decided to focus on the two most important.
The instability and impulsivity that led us to the brink of war with Iran should illustrate the importance of mental capacity in a president, as we describe.
His actions are exactly what we would predict from an individual who lacks mental capacity.
Much of this may have been preventable if we had regular fitness-for-duty tests for presidents and vice presidents before they even take office.
All military personnel who handle nuclear weapons must pass rigorous psychological testing before they assume their duties, and must renew it every year.
Yet the person who commands nuclear weapons does not. What we performed was a mental capacity evaluation. It tests function, not diagnosis, and in this case the ability of someone to make sound decisions free of impulsivity, recklessness, paranoia, and false beliefs.
To demonstrate mental capacity, one has to be able to take in information and advice; to appreciate and make flexible use of that information; to consider consequences based on rational, reality-based, and reliable thinking without undue interference from impulsivity, conspiracy theories, emotional needs, or fluctuating inconsistency; and to refrain from behavior that places oneself or others in danger.
Mr. Trump showed enough evidence to both allies and opponents, as well as in his incitement to violence in public, that he did not possess these abilities.
Our work is not about Mr. Trump, who may not be a danger as a private citizen, but about protecting society against the powers of the presidency in a person who has not demonstrated the ability to handle them.
As the evidence was overwhelming, and since outside perspectives are more important in a functional exam than a personal interview, we did not feel we needed one.
The wealth and quality of the report’s content made this possible.
In fact, we had more and better data, under sworn testimony, than we have ever had in our usual practice.
Still, we wished to offer the president the opportunity to present for an exam if he believed himself fit, and we asked him to give us an answer within three weeks.
While his staff let us know that our request was received, there has been no response about a personal exam.
Hence, we proceeded with our conclusion and recommendations.
A capacity evaluation is different from a diagnostic exam for the purpose of treating a patient.
A diagnosis has nothing to do with a person’s ability to function in a job.
Many individuals with diagnoses of mental illness get the help they need and function perfectly well at work.
We are also not interested in a diagnosis because the president is not our patient.
Our primary responsibility is to protect public health and safety, as our professional ethics require.
Capacity evaluations are usually performed for employers, not patients, and the employers in the case of a president are the people.
Our findings also certify the observations of our public-service book, “The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President.”
We predicted two years ago that Mr. Trump would grow worse under the pressures and the powers of the presidency.
Having a president who lacks capacity is like having a captain who is asleep at the wheel—only worse, since many people will not recognize that he is asleep.
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Reporters need to stop covering him as if he’s strictly a political one
–Dr. John Gartner, Founder of Duty To Warn and co-editor of “Rocket Man: Nuclear Madness and the Mind of Donald Trump,” joins David to discuss the mental health conditions he believes Donald Trump has, which would justify his removal from the Presidency under the 25th Amendment to the Constitution
. . Multiple conditions: malignant narcissism, paranoia, social apathy, sadism ….. UGH! I’ll go back to the original work of Erich Fromm