1. Narcissism G505 Presentation: March 6, 2007 Kelli Brown Greg Hetrick Diana Mann Alexa Yarnelle

2. The Greek Myth Narcissus rejected the Nymph Echo He was cursed to fall in love with his own reflection.

3. Narcissus

4. The Greek Myth (cont.) He eventually changed into the flower, Narcissus

5. Narcissistic Personality Disorder According to the DSM-IV-TR: “a pervasive pattern of grandiosity, need for admiration, and lack of empathy that begins by early adulthood and is present in a variety of contexts.” “a pervasive pattern of grandiosity, need for admiration, and lack of empathy that begins by early adulthood and is present in a variety of contexts.” A Cluster B disorder that falls under the same cluster as Antisocial Personality Disorder, Borderline Personality Disorder, and Histrionic Personality Disorder (dramatic, emotional, or erratic disorders). A Cluster B disorder that falls under the same cluster as Antisocial Personality Disorder, Borderline Personality Disorder, and Histrionic Personality Disorder (dramatic, emotional, or erratic disorders).

6. Diagnostic Criteria (Five or more criteria must be met for a diagnosis) 1) Grandiose sense of self importance Exaggerates achievements and talents Exaggerates achievements and talents Expects to be recognized as superior Expects to be recognized as superior Counselors—look for: -boastful, pretentious behavior -surprise when they don’t receive praise -minimizing the efforts and contributions of others

7. Diagnostic Criteria (Five or more criteria must be met for a diagnosis) 2) Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. Counselors—look for: -clients comparing themselves to famous or prestigious/privileged people

8. Diagnostic Criteria (Five or more criteria must be met for a diagnosis) 3) Believe they are special and unique and can only be understood by, or should associate with, other special or high-status people (or institutions). Counselors—look for: -clients who exclude others because they are simply not good enough. -saying they can only be understood by approved people -placing a high value on the people chosen to associate with -insisting on always having the “best” individual provide services for them (teacher, doctor, etc.)

9. Diagnostic Criteria (Five or more criteria must be met for a diagnosis) 4) Requires excessive admiration Counselors—look for: -fragile self-esteem -preoccupation with the opinions others have of them -expectation of others to covet their belongings and achievements -fishing for compliments

10. Diagnostic Criteria (Five or more criteria must be met for a diagnosis) 5) Has a sense of entitlement (unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations). Counselors—look for: -clients who expect all others to cater to them -belief that the work they do is “very important” and others should help them unquestioningly

11. Diagnostic Criteria (Five or more criteria must be met for a diagnosis) 6) Is interpersonally exploitative (takes advantage of others to achieve his or her own ends Counselors--look for: -a lack of sensitivity to the needs and wants of others -expecting far too much out of other people -forming relationships that simply enhance their self-esteem -being greedy with material resources

12. Diagnostic Criteria (Five or more criteria must be met for a diagnosis) 7) Lack of Empathy: unwilling to recognize or identify with the feelings and needs of others. Counselors—look for: -trouble understanding the subjective experiences of others -discussing their own concerns in lengthy detail -impatience when others talk about their own concerns -saying hurtful comments (ex: bragging to an ex about a new relationship; bragging about health to a sick person) -seeing the problems of others as weaknesses

13. Diagnostic Criteria (Five or more criteria must be met for a diagnosis) 8) Often envious of others or believes that others are envious of him or her. Counselors—look for: -thinking they are more deserving than others of positive consequences -devaluing the admiration given to others

14. Diagnostic Criteria (Five or more criteria must be met for a diagnosis) 9) Shows arrogant, haughty behaviors or attitudes. Counselors—look for: -criticizing the work of others -snobby attitudes, name calling --DSM-IV-TR

15. Personality Descriptors Amoral/consciencelessAuthoritarian Cares only about appearances Contemptuous Critical of others Cruel Disappointing gift-givers Don’t recognize own feelings Envious and competitive Feel entitled Flirtatious or seductive Gradiose Hard to have a good time with Hate to live alone Hyper-sensitive to criticism Lacks sense of humor NaïvePassivePessimisticReligiousSecretiveSelf-ContradictoryStingy Strange work habits Unusual eating habits Weird sense of time ** http://www.halcyon.com/jmas hmun/npd/traits.html#contra ** http://www.halcyon.com/jmas hmun/npd/traits.html#contra

16. Other Characteristics “Haunted” by criticism Low threshold for humiliation Severely impaired relationships Low functioning due to a fear of defeat --DSM-IV-TR

17. NPD is also associated with… Dysthymic or Major Depressive Disorder Hypomanic moods Anorexia Nervosa Substance-related disorders (especially cocaine) Other personality disorders such as Histrionic, Borderline, Antisocial, and Paranoid. --DSM-IV-TR

18. Age of Onset/Gender Features Narcissistic traits common in adolescents Therefore, NDP is not diagnosed until adulthood (if these traits have continued beyond adolescence and caused significant failure in the interpersonal environment). Symptoms are intensified by the aging process, due to physical and occupational limitations. 50-75% diagnosed are male --DSM-IV-TR--http://en.wikipedia.org/wiki/Narcissistic_personality_disorder http://www.mayoclinic.com/health/narcissistic-personality- disorder/DS00652/DSECTION=5

19. Prevalence 2-16% in the clinical population <1% in the general population --DSM-IV-TR

20. Differential Diagnosis NPD is very similar to Histrionic, Antisocial, and Borderline Personality Disorders, except for one important characteristic: GRANDIOSITY GRANDIOSITY

21. When compared to Borderline PD… NPD has a stable self-image NPD has a lack of self-destructiveness, impulsivity and fear of abandonment --DSM-IV-TR

22. When Compared to Histrionic PD… NPD has excessive pride in achievements NPD has a lack of emotional display NPD has lack of concern for others’ sensitivities --DSM-IV-TR

23. When compared to Antisocial PD… NPD is not characteristically impulsive NPD is not an aggressive disorder Individuals with NPD are not purposefully deceitful NPD requires more admiration from others Individuals with NPD may lack the conduct disorder from childhood or criminal behavior in adulthood --DSM-IV-TR

24. When compared to Obsessive- Compulsive Disorder Both have perfectionistic qualities, and the belief that only they can do things right However, people with OCD are more self-criticizing, while people with NPD think they are perfect. --DSM-IV-TR

25. Other Differential Diagnoses When compared to Schizotypal or Paranoid PD… --NPD is not socially withdrawn and suspicious (unless there is fear of defeat or criticism) When compared to Manic/Hypomanic Episodes… --both have grandiose characteristics, but NPD does not have rapid mood change or impaired functioning Also—be sure that symptoms are not the result of Substance Use. --DSM-IV-TR

26. Possible Causes Genetics Twin Study Twin Study Of the 18 personality characteristic measured, narcissism had the highest hertability. --Alvarez study —Assortative mating (“self- seeking like” hypothesis** --http://en.wikipedia.org/wiki/Narcissism

27. Possible Causes (cont.) Unconscious belief that oneself is “flawed in a way that makes the person fundamentally unacceptable to others” Lack of healthy, empathic attachments with primary caregivers. The child begins to feel unwanted and unconnected to others. (http://en.wikipedia.org/wiki/Narcissistic_personality_disorder) http://en.wikipedia.org/wiki/Narcissistic_personality_disorder http://www.mayoclinic.com/health/narcissistic-personality- disorder/DS00652/DSECTION=6

28. Possible Causes (cont.) **According to the Mayo Clinic Website, these developmental or parenting factors may contribute to NPD: An oversensitive temperament at birth Overindulgence and overvaluation by parents Valued by parents as a means to regulate their own self-esteem Excessive admiration that is never balanced with realistic feedback Unpredictable or unreliable caregiving from parents Severe emotional abuse in childhood Being praised for perceived exceptional looks or talents by adults Learning manipulative behaviors from parents http://www.mayoclinic.com/health/narcissistic-personality-disorder/DS00652/DSECTION=3

29. Narcissistic Parents See children as “extensions of themselves,” and pressure them to act according to their unreachable standards. Overly intrusive or neglectful Harsh punishments including physical abuse, blame, guilt, criticism, emotional neglect, etc. (http://en.wikipedia.org/wiki/Narcissistic_personality_disorder)

30. Environmental Factors: “Co-Narcissism” Narcissists look for this trait in their mates, encourage it in their children. Characterized by being passive and compliant to the demands of others Easily accepts blame Accept others’ opinions “Co-Dependent personality style similar to co- alcoholism and co-dependency.” (http://en.wikipedia.org/wiki/Narcissistic_personality_disorder)

31. Treatment Strategies Difficult, because most people with NPD will not seek treatment, due to the characteristics of the disorder Usually directed by others to begin therapy (unwillingly) People with NPD fear that therapy will expose their weaknesses http://www.mayoclinic.com/health/narcissistic-personality- disorder/DS00652/DSECTION=6

32. Treatment Strategies (cont.) Individual psychotherapy is the most common form of treatment (sometimes group and family counseling is incorporated) Pharmacotheraphy is rarely used to treat NPD itself, but meds may be suggested to treat other symptoms such as depression or anxiety. http://www.mayoclinic.com/health/narcissistic-personality- disorder/DS00652/DSECTION=6

33. Prognosis Success of psychotherapy depends on the severity of the case Other related problems that may arise as a result of NPD: Relationship and family problems Relationship and family problems Substance abuse and dependence Substance abuse and dependencehttp://www.nlm.nih.gov/medlineplus/ency/article/000934.htm

34. A Side Note… Many people display Narcissistic-type personality characteristics, especially people who are successful and competitive NPD is only a Disorder when the characteristics are inflexible, maladaptive, and cause significant impairment or distress. --DSM-IV-TR

35. Assessment Strategies Personality Disorder Test Handed out in class Handed out in class

36. References DSM-IV-TRWikipedia.com: http://en.wikipedia.org/wiki/Narcissistic_personality_disorder http://en.wikipedia.org/wiki/Narcissistic_personality_disorder http://en.wikipedia.org/wiki/Narcissistic_personality_disorder http://en.wikipedia.org/wiki/Narcissism http://en.wikipedia.org/wiki/Narcissism http://en.wikipedia.org/wiki/Narcissism Mayo Clinic Online: http://www.mayoclinic.com/health/narcissistic-personality- disorder/DS00652/DSECTION=5 http://www.mayoclinic.com/health/narcissistic-personality- disorder/DS00652/DSECTION=5 http://www.mayoclinic.com/health/narcissistic-personality- disorder/DS00652/DSECTION=5 http://www.mayoclinic.com/health/narcissistic-personality- disorder/DS00652/DSECTION=5 http://www.mayoclinic.com/health/narcissistic-personality- disorder/DS00652/DSECTION=6 http://www.mayoclinic.com/health/narcissistic-personality- disorder/DS00652/DSECTION=6 http://www.mayoclinic.com/health/narcissistic-personality- disorder/DS00652/DSECTION=6 http://www.mayoclinic.com/health/narcissistic-personality- disorder/DS00652/DSECTION=6 http://www.mayoclinic.com/health/narcissistic-personality- disorder/DS00652/DSECTION=3 http://www.mayoclinic.com/health/narcissistic-personality- disorder/DS00652/DSECTION=3 http://www.mayoclinic.com/health/narcissistic-personality- disorder/DS00652/DSECTION=3 http://www.mayoclinic.com/health/narcissistic-personality- disorder/DS00652/DSECTION=3 MedicinePlus Medical Encyclopedia: http://www.nlm.nih.gov/medlineplus/ency/article/000934.htm http://www.nlm.nih.gov/medlineplus/ency/article/000934.htm http://www.nlm.nih.gov/medlineplus/ency/article/000934.htm

37. References (cont.) Personalilty Disorder Test Sources: http://www.nightingale- center.com/archive/narcissist.html http://www.nightingale- center.com/archive/narcissist.html http://www.wellesley.edu/Psychology/Cheek/se nsitive.html http://www.wellesley.edu/Psychology/Cheek/se nsitive.html http://npatest.homestead.com/files/NPAtest.ht m http://npatest.homestead.com/files/NPAtest.ht m

38. References (cont.) 1) L.L. (Subject A). Personal Interview. 27 Feb. 2007. 2) L.L. (Subject A). E-mail communications. April 2005-February 2007. 3) L.L. (Subject A). Personal Narrative. April 2005. 3) Rayment, W.J. Jean Piaget and Child Development. 25 Jan. 2007. 28 Feb. 2007 http://www.indepthinfo.com/articles/piaget- developmental-psychology.shtml. http://www.indepthinfo.com/articles/piaget- 4) Girl, Interrupted, Dir. James Mangold, Columbia Pictures, 1999. 5) Monster-in-Law, Dir. Robert Luketic, New Line Cinema, 2005.