January 27, 2023

A Lagos-based medical doctor and mental health advocate, Dr. Jennifer Chudi-Emokai, speaks with GODFREY GEORGE about the symptoms and management of narcissism, a mental health condition

What is narcissism?

Narcissism can also be referred to as narcissistic personality disorder, which is the more medically-appropriate term. It is a pervasive pattern of grandiosity – in fantasy or behavior – need for admiration and lack of empathy, beginning by early adulthood. NPD is a mental health condition in which people have an unreasonably high sense of their importance. They need and seek too much attention and want people to admire them. People with this disorder may lack the ability to understand or care about the feelings of others. People with NPD may be generally unhappy and disappointed when they’re not given the special favours or admiration that they believe they deserve. They may find their relationships troubled and unfulfilling, and other people may not enjoy being around them. A person with NPD may have problems in many areas of life, such as relationships, work, school, or financial matters.

How is it diagnosed?

Diagnosis of narcissistic personality disorder, typically, is based on signs and symptoms, physical examination, and thorough psychological evaluation.

Can one self-diagnose?

Only a licensed mental health professional can diagnose NPD. This is because one may be living in denial even when all symptoms and signs say otherwise. So, a health care provider, most especially, a psychiatrist, would be the best to go to handle this issue.

What are the types of narcissism?

Narcissistic personality disorder includes three types. There is the overt, grandiose, and stereotypical loud. There is also the covert, where sufferers are more fragile, self-effacing, and overly aware of others. Thirdly, there is the malignant, which is a combination of narcissistic personality disorder and antisocial personality disorder.

Are there character traits that predispose one to become narcissistic?

It is unclear if there are some traits that predispose one to this disorder. Narcissistic personality disorder affects more males than females, and it often begins in adolescence or early adulthood. They often have high self-esteem and may believe they are special or superior to others. However, they seem to need excessive praise and admiration and may react poorly to perceived criticism. Narcissists also tend to exaggerate their talents and accomplishments while downplaying those of others. They’re usually preoccupied with power, success, and beauty. They might even engage in impulsive behaviors such as gambling or certain sexual behaviors which may not follow ‘regular patterns’.

Some children may show traits of narcissism. This may simply be typical of their age and does not mean they will go on to develop a narcissistic personality disorder.

How does it present in children?

Narcissistic children find it difficult to establish relationships with others; also, opportunism and arrogance can be indicative of this behavior.

Is NPD a mental disorder?

Yes, narcissism is one of several types of personality disorders or mental conditions. The disorder is used to describe someone who acts self-absorbed, but what many people don’t know is that narcissism or NPD is actually a serious mental health condition. If you have an NPD diagnosis, others may see you as only concerned about your wants and needs or having a never-ending need for compliments. But inside, you may feel insecure, less-than, and empty. Having NPD makes it hard to relate to others or have genuine self-worth. It can affect relationships with your family, friends, and co-workers.

People with NPD may not want to think that anything could be wrong, so they usually don’t seek treatment. If they do seek treatment, it’s more likely to be for symptoms of depression, drug or alcohol misuse, or another mental health problem. What they view as insults to self-esteem may make it difficult to accept and follow through with treatment.

If you recognise aspects of your personality that are common to narcissistic personality disorder or you’re feeling overwhelmed by sadness, consider reaching out to a trusted healthcare provider or mental health provider. Getting the right treatment can help make your life more rewarding and enjoyable.

What exactly causes this disorder?

The exact cause of narcissistic personality disorder isn’t known but some researchers think that in biologically-vulnerable children, parenting styles that are overprotective or neglectful may have an impact. Also, genetics and neurobiology may play a role in the development of NPD.

Narcissists’ positive but insecure self-views lead them to be more attentive and reactive to feedback from other people. However, not just any response or feedback from others is important to narcissists; they are eager to learn that others admire and look up to them. Narcissists value admiration and superiority more than being liked and accepted. Studies find that narcissists’ self-esteem depends upon the extent to which they feel admired. Moreover, narcissists pursue admiration from others by attempting to manipulate the impressions they create in others. They also respond with anger and resentment when they feel threatened by others. They are more likely to respond aggressively on such occasions and derogate those who threaten them even when such a hostile response jeopardizes the relationship.

Findings from a range of studies suggest that narcissists are people who use their friends to feel good about themselves. They desire attention and admiration to support self-images that are positive but easily threatened. They are constantly on alert for even the smallest slight that they perceive as disrespect.

What other symptoms should people look out for?

According to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), the presence of at least five out of the following nine criteria can be an issue. Some of the symptoms include a grandiose sense of self-importance, and preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love. There may be a belief that he or she is special and unique and can only be understood by or should associate with other special or high-status people or institutions. They have an insatiable need for excessive admiration. They may also have a strange sense of entitlement and may express deep interpersonally exploitative behaviours. They generally lack empathy and envy others with the belief that others are envious of them. They may be seen as highly arrogant, too.

Are these symptoms mild or severe?

These symptoms can either be severe or mild and can vary from person to person. At the same time, people with narcissistic personality disorder have trouble handling anything they view as criticism. They can become impatient or angry when they don’t receive special recognition or treatment. They may have major problems interacting with others and easily feel slighted. They often react with rage or contempt and try to belittle other people to make themselves appear superior. They may have difficulty managing their emotions and behaviour and may experience major problems dealing with stress and adapting to change. They may withdraw from or avoid situations in which they might fail, feel depressed and moody because they fall short of perfection, and have secret feelings of insecurity, shame, humiliation, and fear of being exposed as a failure.

Do people living with this condition have issues with recognising reality?

A narcissist can be a great storyteller. They captivate you with tales of personal triumphs, heroism, and even selflessness. But it’s when you look behind the curtain that you discover they’ve rewritten history. Not only are they living in a fantasy, their readers believed all their self-mythology. It is hard to recognise if one has a narcissistic personality because the symptoms of this disorder almost preclude self-awareness. But people have the power to ask themselves, “Do I have narcissistic personality disorder?”And if one recognises the signs, one can accept them, cope with them, get treated for them, and live with them and with other people.

How does narcissism differ from bipolar disorder?

Bipolar disorder is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). Narcissism is a personality disorder that affects how a person feels, thinks, and acts.

How true is it that the disorder can distort one’s personality?

It is true that people with personality disorders often don’t realise their thoughts and behaviors are problematic. According to the Mayo Clinic, NPD is a mental disorder in which people have an inflated sense of their own importance and a deep need for admiration. Those with narcissistic personality disorder believe that they’re superior to others and have little regard for other people’s feelings. But behind this mask of ultra-confidence lies a fragile self-esteem, vulnerable to the slightest criticism.

Some people are narcissistic but do not have a mental illness. These people feel superior to others and see nothing wrong with that. They have little or no empathy for the feelings, conditions, situations, or plight of others. These are people who feel entitled to the best of everything while looking down on those who show admiration for them. They also have no difficulty exploiting others to get what they want. It’s important to understand that they have no awareness and no insight into what they do. As a result, they feel no shame or remorse.

You mentioned earlier that genetics and neurobiology may play a role in the development of NPD. Is it hereditary?

Yes, research has shown that distinct genetic and environmental factors modulate grandiosity and entitlement via different brain regions. It would seem reasonable to assume though, at this stage, there is not a shred of proof that the narcissist is born with a propensity to develop narcissistic defences. These are triggered by abuse or trauma during the formative years in infancy or during early adolescence. By “abuse” I am referring to a spectrum of behaviours that objectifies the child and treats it as an extension of the caregiver (parent) or an instrument. And abuse can be dished out by peers as well as by adult role models. Still, I would have to attribute the development of NPD mostly to nurture.

How does a narcissistic person present in the workplace?

A narcissist will always try to undermine what others say to prove that their viewpoint is superior. This can lead to a sense of inferiority complex among team members, which can lower employees’ confidence. Narcissists in the workplace principally make others unhappy, often leading to those employees exhibiting healthy worker syndrome and moving their employment to another organisation, either because they are unable or unwilling to articulate the problem or because human resources or managers will not listen or act on their deputations.

Narcissists rely on narcissistic supply (harnessing other people’s goodwill to feed their vision of themselves). Any challenge to that belief may be met with aggression as it strikes at the core of the narcissists’ fantasy of themselves.

How does the condition affect interpersonal relationships?

Being in a relationship with someone who has NPD can be challenging. Narcissists tend to have an inflated sense of ego and entitlement, put themselves first, lack empathy and can become abusive to others. Hence, research findings show that NPD symptoms and behaviors will negatively impact interpersonal relationships across all areas of life.

How does it show in marriage?

The very traits that attracted a person to a narcissist are often the ones that can make the relationship super difficult. Sometimes, the signs of narcissism don’t become truly apparent until after marriage. A narcissistic partner often isolates their spouses from their family and friends. They gaslight their partners. Narcissists may talk glowingly about an ex or flirt with someone right in front of you. Narcissistic partners can become resentful of the time invested in childcare.

Can this condition cause depression?

Yes, it can cause depression. We do know that clinical narcissism increases the likelihood of depression, though researchers don’t know why exactly. There are a few speculations for the cause of co-occurring depression. Self-esteem challenge is one. Research has shown this occurring in people with vulnerable narcissism. Secondly, there may be signs of a perceived lack of attention and validation. Those with NPD may not have the proper coping skills to manage inattention and shame.

Thirdly, there may be differences in perception. They may become confused and discouraged when others don’t see them as positively as they see themselves or don’t recognise or agree with their perceived victimisation. They may go through chronic stress. They may become stressed over interpersonal problems associated with their behaviors.

What help can people living with this condition seek?

They can seek professional help. NPD treatment is centered around talk therapy. Therapy for NPD will involve helping them overcome resistance to therapy, identifying narcissistic behaviors that are causing problems in their life, examining past experiences and assumptions that led to narcissistic behaviours, acknowledging how these behaviors affect others, replacing grandiose thoughts with more realistic ones, exploring new patterns of behavior and practicing them and seeing the benefits of newly learned behaviors.

Is there a permanent cure?

There is no cure, but therapy can help.

What should be the reaction of people around people living with the condition?

There are some ways to help people deal with Narcissistic partners. They should be educated about NPD, build self-esteem, speak up for themselves, set clear boundaries, and practice skills to keep calm while finding a support system.

How accessible is the care for people with the condition?

There are accessible centers for the care of people with this condition.

How bad can the condition get without treatment?

People with NPD have difficulty admitting that the problem is with them; they’d rather believe that the problem is in the world and the people around them who can’t meet their standards. Because of this, many of them continuously have failed relationships. Their failed relationships may lead to depression, and taking alcohol and other substances they believe can make them feel good about themselves.

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