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Dr. Paul LatimerIs narcissism actually a disorder or is it just a description of someone who happens to be more self-absorbed than most?

We all know people who seem to focus almost solely on themselves with little interest in the feelings or contributions of others. But where does selfishness end and narcissistic personality disorder begin?

Narcissistic personality disorder is defined as a pattern of grandiosity, need for admiration and lack of empathy for others. This pattern begins by early adulthood, is present in many contexts and indicated by at least five of the major symptoms.

Characteristics include having an exaggerated sense of self-importance and an expectation of being recognized as superior to others. Also, narcissists may have a preoccupation with fantasies of unlimited success, power, brilliance, beauty or ideal love.

A narcissist may believe that he or she is ‘special’ and unique and can only be understood by other special or high status individuals or institutions. In addition, narcissists require excessive admiration and have a sense of entitlement with unreasonable expectations of especially favourable treatment or automatic compliance from others.

Other characteristics of this personality type include taking advantage of others to achieve goals, lacking empathy, being envious of others or believing others are envious of him or her, and showing arrogant, haughty behaviour and attitudes.

Narcissism is not the same as high self-esteem, although they are correlated. People with high self-esteem are not necessarily narcissistic but rather confident of their personal worth. Their esteem is based on a realistic appraisal of their talents and achievements and for them, corrective feedback does not trigger a dramatic loss of self-esteem.

Most important to the diagnosis of a disorder rather than simply run-of-the-mill selfishness is the long-term pattern of abnormal thinking that is associated with these traits as well as the pervasiveness and scale of the accompanying behaviours.

In general, narcissists tend to show their exaggerated sense of self-importance by talking about family, work and life as if there is nobody else in the picture. Often, they give the impression that they are bearing martyr-like responsibility due to the incompetence of others in their lives.

When someone acts in these ways, it will seem peculiar or disturbing to observers.

Not surprisingly, people with narcissistic personality disorder tend to have difficulty in relationships and work situations. Unfortunately, narcissists won’t or can’t change their behaviour even when it does cause problems, because they don’t recognize themselves as the problem.

This lack of insight makes narcissistic personality disorder very difficult to treat. Patients don’t recognize that they have a disorder or weakness and instead become very resentful of anyone who tells them otherwise.

While attempting to maintain a sense of superiority, narcissists tend to display contempt for physicians and other health care workers and will often only respect the senior physician as someone worthy to speak with.

No medication exists to specifically treat narcissistic personality disorder. Instead, doctors generally focus on coexisting problems such as depression or other crises rather than directly confronting the personality disorder itself.

If trust is formed between patient and physician, some counseling focusing on a step-by-step confrontation of behaviours and feelings can be helpful.

Dr. Latimer is president of Okanagan Clinical Trials and a Kelowna psychiatrist.


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