Mental Health and Illness

Narcissistic Personality

Narcissistic Personality Disorder (NPD) is a mental health condition characterized by a pervasive pattern of grandiosity, a need for admiration, and a lack of empathy for others. People with NPD often have an inflated sense of self-importance and believe they are special, unique, or superior to others. They may feel entitled to special treatment or recognition, and expect others to meet their needs without question. Additionally, they may become preoccupied with fantasies of power, wealth, or success, and may engage in excessive attention-seeking behaviors to maintain their self-esteem.

Individuals with NPD may struggle with relationships as they often exploit others for their own benefit, and may become angry or hostile when they perceive a threat to their self-esteem or sense of superiority. They may also struggle with feelings of shame, insecurity, and vulnerability, which they may mask with defensive behaviors, such as arrogance, denial, or belittling others.

NPD is typically diagnosed by a mental health professional, who will conduct a thorough psychological evaluation to assess symptoms and rule out other possible causes.

Diagnosis of NPD

Here are the DSM-5 diagnostic criteria for NPD:

A. Significant impairments in personality functioning manifest by:

1. Impairments in self-functioning (a or b): a. Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem. b. Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.
2. Impairments in interpersonal functioning (a or b): a. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others. b. Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others' experiences and predominance of a need for personal gain.

B. Pathological personality traits in the following domains:

1. Antagonism, characterized by:
  - a. Grandiosity: Feelings of entitlement, either overt or covert; self-centeredness; firmly holding to the belief of being unique or special.
  - b. Attention seeking: Excessive attempts to attract and be the focus of attention of others; admiration seeking.

C. The impairments in personality functioning and the individual's personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual's personality trait expression are not better understood as normative for the individual's developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual's personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head injury).

F. The impairments in personality functioning and the individual's personality trait expression are not better understood as symptoms of another mental disorder.

The Difference Between Malignant Narcissism and Covert Narcissism

Malignant and covert narcissism are both subtypes of narcissistic personality disorder (NPD), but they manifest in different ways.

Malignant Narcissism

Malignant narcissism is a more severe and aggressive form of narcissism that includes traits of narcissistic personality disorder along with antisocial behavior, paranoia, and sadism. Key characteristics include:

Extreme entitlement and grandiosity – They believe they are superior and deserve special treatment.
Lack of empathy – They disregard the feelings and well-being of others.
Manipulation and exploitation – They use deception, lies, and intimidation to control people.
Vindictiveness – They hold grudges and seek revenge when challenged.
Aggression and cruelty – They may enjoy causing pain or humiliation to others.
Paranoia – They often believe others are out to get them.

Malignant narcissists can be very dangerous because their need for power and control can lead them to harm others without remorse.

Covert Narcissism

Covert narcissism, also known as vulnerable narcissism, is a less obvious form of narcissism that presents with insecurity and passive-aggressiveness rather than overt grandiosity. Key traits include:

False humility – They may appear shy or modest but still crave admiration.
Passive-aggressiveness – They manipulate through guilt, silent treatment, or subtle put-downs.
Victim mentality – They often see themselves as victims and seek sympathy.
Hypersensitivity to criticism – They react strongly to perceived slights or rejection.
Envy and resentment – They may secretly feel superior but are also bitter toward those who succeed.

Covert narcissists can be emotionally draining, as they use subtle tactics to gain control and validation without the blatant arrogance of an overt narcissist.

Key Differences

Trait	Malignant Narcissism	Covert Narcissism
Aggressiveness	High (overt, direct)	Low (passive-aggressive)
Manipulation Style	Dominating, bullying	Subtle, guilt-tripping
Empathy	Nonexistent	Limited, but may fake it
Public Image	Arrogant, domineering	Self-effacing, victimized
Response to Criticism	Rage, retaliation	Withdrawal, self-pity
Level of Danger	High (can be abusive, exploitative)	Moderate (emotionally manipulative)

Both types can be harmful, but malignant narcissists are often more outwardly destructive, while covert narcissists can be emotionally draining in a more subtle way.

Treatment for Narcissistic Personality

Treatment for NPD typically involves psychotherapy, specifically cognitive-behavioral therapy (CBT) and psychodynamic therapy.

CBT focuses on identifying and changing problematic thoughts and behaviors associated with NPD. This may include exploring patterns of thinking that contribute to a person's sense of superiority or entitlement, and teaching them new, more adaptive ways of thinking and behaving. CBT may also involve developing new coping strategies to help individuals manage difficult emotions or interpersonal conflicts.

Psychodynamic therapy, on the other hand, focuses on exploring the unconscious motivations and conflicts that underlie a person's NPD. This may involve examining early childhood experiences, such as neglect or trauma, that may have contributed to a person's development of NPD. Psychodynamic therapy may also help individuals develop greater self-awareness and insight into their behaviors and relationships.

In addition to therapy, medication may also be prescribed to treat co-occurring mental health conditions, such as depression or anxiety, which may be present in individuals with NPD.

It's important to note that treatment for NPD can be challenging, as individuals with NPD may be resistant to therapy or may struggle to acknowledge their need for treatment. However, with the right support and approach, many people with NPD can make significant progress in managing their symptoms and improving their relationships with others.

Self-help for Narcissistic Personality

It is important to note that managing Narcissistic Personality Disorder (NPD) on one's own can be challenging, and seeking professional help is highly recommended. However, if a person is interested in managing their symptoms on their own, here are ten things they can try:

Practice self-reflection: Take time to reflect on your thoughts, feelings, and behaviors. Journaling can be a helpful tool for this.
Challenge your beliefs: Work to challenge your belief in your superiority or entitlement. Ask yourself if your thoughts are based on facts or just assumptions.
Practice empathy: Work on understanding other people's perspectives and feelings. This can help you develop more meaningful relationships.
Develop self-compassion: Be kind and compassionate toward yourself. Try to forgive yourself for past mistakes and focus on self-improvement.
Set realistic goals: Set achievable goals for yourself that are based on your actual abilities, rather than your idealized self-image.
Accept feedback: Be open to feedback from others, even if it's critical. This can help you grow and develop as a person.
Learn healthy coping skills: Practice healthy coping skills, such as mindfulness, meditation, or exercise, to manage stress and difficult emotions.
Avoid self-destructive behaviors: Be aware of self-destructive behaviors, such as substance abuse or risky sexual behaviors, and work to avoid them.
Build a support system: Surround yourself with supportive friends and family members who can help you through difficult times.
Seek professional help: Consider seeking professional help from a therapist or psychiatrist who specializes in treating NPD. They can provide valuable guidance and support as you work to manage your symptoms.

Mental Health and Illness

Narcissistic Personality

NPD is typically diagnosed by a mental health professional, who will conduct a thorough psychological evaluation to assess symptoms and rule out other possible causes.

Diagnosis of NPD

Here are the DSM-5 diagnostic criteria for NPD:

A. Significant impairments in personality functioning manifest by:

B. Pathological personality traits in the following domains:

Antagonism, characterized by:

a. Grandiosity: Feelings of entitlement, either overt or covert; self-centeredness; firmly holding to the belief of being unique or special.

b. Attention seeking: Excessive attempts to attract and be the focus of attention of others; admiration seeking.

C. The impairments in personality functioning and the individual's personality trait expression are relatively stable across time and consistent across situations.

D. The impairments in personality functioning and the individual's personality trait expression are not better understood as normative for the individual's developmental stage or socio-cultural environment.

E. The impairments in personality functioning and the individual's personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head injury).

F. The impairments in personality functioning and the individual's personality trait expression are not better understood as symptoms of another mental disorder.

The Difference Between Malignant Narcissism and Covert Narcissism

Malignant and covert narcissism are both subtypes of narcissistic personality disorder (NPD), but they manifest in different ways.

Malignant Narcissism

Malignant narcissism is a more severe and aggressive form of narcissism that includes traits of narcissistic personality disorder along with antisocial behavior, paranoia, and sadism. Key characteristics include:

Extreme entitlement and grandiosity – They believe they are superior and deserve special treatment.

Lack of empathy – They disregard the feelings and well-being of others.

Manipulation and exploitation – They use deception, lies, and intimidation to control people.

Vindictiveness – They hold grudges and seek revenge when challenged.

Aggression and cruelty – They may enjoy causing pain or humiliation to others.

Paranoia – They often believe others are out to get them.

Malignant narcissists can be very dangerous because their need for power and control can lead them to harm others without remorse.

Covert Narcissism

Covert narcissism, also known as vulnerable narcissism, is a less obvious form of narcissism that presents with insecurity and passive-aggressiveness rather than overt grandiosity. Key traits include:

False humility – They may appear shy or modest but still crave admiration.

Passive-aggressiveness – They manipulate through guilt, silent treatment, or subtle put-downs.

Victim mentality – They often see themselves as victims and seek sympathy.

Hypersensitivity to criticism – They react strongly to perceived slights or rejection.

Envy and resentment – They may secretly feel superior but are also bitter toward those who succeed.

Covert narcissists can be emotionally draining, as they use subtle tactics to gain control and validation without the blatant arrogance of an overt narcissist.

Key Differences

Trait

Malignant Narcissism

Covert Narcissism

Aggressiveness

High (overt, direct)

Low (passive-aggressive)

Manipulation Style

Dominating, bullying

Subtle, guilt-tripping

Empathy

Nonexistent

Limited, but may fake it

Public Image

Arrogant, domineering

Self-effacing, victimized

Response to Criticism

Rage, retaliation

Withdrawal, self-pity

Level of Danger

High (can be abusive, exploitative)

Moderate (emotionally manipulative)

Both types can be harmful, but malignant narcissists are often more outwardly destructive, while covert narcissists can be emotionally draining in a more subtle way.

Treatment for Narcissistic Personality

Treatment for NPD typically involves psychotherapy, specifically cognitive-behavioral therapy (CBT) and psychodynamic therapy.

In addition to therapy, medication may also be prescribed to treat co-occurring mental health conditions, such as depression or anxiety, which may be present in individuals with NPD.

Self-help for Narcissistic Personality

It is important to note that managing Narcissistic Personality Disorder (NPD) on one's own can be challenging, and seeking professional help is highly recommended. However, if a person is interested in managing their symptoms on their own, here are ten things they can try:

Practice self-reflection: Take time to reflect on your thoughts, feelings, and behaviors. Journaling can be a helpful tool for this.

Challenge your beliefs: Work to challenge your belief in your superiority or entitlement. Ask yourself if your thoughts are based on facts or just assumptions.

Practice empathy: Work on understanding other people's perspectives and feelings. This can help you develop more meaningful relationships.

Develop self-compassion: Be kind and compassionate toward yourself. Try to forgive yourself for past mistakes and focus on self-improvement.

Set realistic goals: Set achievable goals for yourself that are based on your actual abilities, rather than your idealized self-image.

Accept feedback: Be open to feedback from others, even if it's critical. This can help you grow and develop as a person.

Learn healthy coping skills: Practice healthy coping skills, such as mindfulness, meditation, or exercise, to manage stress and difficult emotions.

Avoid self-destructive behaviors: Be aware of self-destructive behaviors, such as substance abuse or risky sexual behaviors, and work to avoid them.

Build a support system: Surround yourself with supportive friends and family members who can help you through difficult times.

Seek professional help: Consider seeking professional help from a therapist or psychiatrist who specializes in treating NPD. They can provide valuable guidance and support as you work to manage your symptoms.