La Coop P.A.- General and Forensic Psychiatry - Boutique-Private Psychiatric and Forensic Practice in Tampa-Clearwater-Florida

Narcissistic Personality Disorder (NPD) I know it when I see it...

People ask me about this disorder and how to identify this, mostly in the court setting and I typically say, "I know it when I see it." I forget that I have a lot of training and experience in this.

Now, with any personality disorder - it is a longstanding problem. This isn't something that just pops up in a day. These characteristics are seen from a very young age and may get more intense as they come into their own as an adult. These people have a sense of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy. Actual criteria are the following:

• The person has a grandiose sense of self-importance. This means that they exaggerate their achievements and talents because they expect to be recognized as superior regardless of their achievements. I see this a lot which is why I ask so many questions and investigate when things don't seem right. This is why I tell patients in a relationship with a person like this, or who have a child like this that we need to do groundwork. We want to give people credit where credit is due, but just not assume that someone is 'all that' just because they say they are. Why is that important? Because a lot of time they use this 'experience' as a way to put you down. We need to be sure when we're dealing with people like this that we are dealing on an even playing field - no matter what the field looks like.
• They are preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. I see this alot in kids and this doesn't necessarily mean anything. Many kids have fantasies and that's fine, but when the 'kid' is 26 - we need to reassess. Are they fantasizing about achievements that are unobtainable? Can these things be obtained? The problem comes when adults try to put these expectations on those around them that are not only unreasonable, but for some they are not achievable. It leads to poor self esteem when it really doesn't need to be there. Again, with this personality style you always have to cross check and ask yourself - "Is this person for real?"
• They believe that they are "special" and unique. Now we all are special and unique and again it's nice to be recognized by someone you care about for the good qualities you have (I must thank my husband for all of his compliments daily that make me feel good even though I know they are coming from a biased source). People with Narcissistic Personality Disorder (NPD) believe that because they are extra special that they can only be understood by, or should associate with, other special or high-status people (or institutions). Just remember when you are with a person like this and they always need to go to the next level, or need special favors, or request those from you - there is an issue there that needs to be addressed in them. Remember - it's not just YOU that has a problem with this behavior.
• The person requires excessive admiration. I'm not talking about a little note once in a while. I'm not talking about a pat on the back. This person believes that they are a GOD in some sense. They believe on some level that the world revolves around them and their needs. Again, with kids one might see this sometimes, but it's not to this degree. And even in kids, we need to tone it down a little bit. I see a lot of parents and I hear many of them talk about their kids as if the world did revolve around them. It's not really the case. Kids need to know that they are kids and that not all things are going to be perfect and not everything is going to be laid out for them. It's not the duty of the parents to make their child's life perfect as if they lived in a fantasy. This is where I see this personality disorder coming from. Unfortunately, this is getting more and more common. So, parents take heed.
• The person has a sense of entitlement. I deal with this a lot. These people want what they want, when they want it, and how they want it. If it's not their way - it's WRONG. Well, they are wrong. These expectations are largely unreasonable. I actually had this happen to me not 2 days ago. A patient's boyfriend calls (not the patient) and demands her medication be filled in another city RIGHT NOW. Now, this person was told by myself to pick up their meds from their home store before they left (they had medication with refills called in) and they chose not to. Now this person believes that they are more important than all of my other patients and that I can stop what I'm doing with the patient I'm seeing to take care of their request. You can imagine that these things are not only rude, but are just outrageous displays of narcissism! I'm sure you can come up with some examples of your own if you live with a person like this. Ex. Meals on the table at this specific time at all costs. Shirts ironed now. Taking hours of your time to do things for them regardless of what you need to do for you. In reality - they have no care about your needs except as it relates to them and their needs.
• The person is interpersonally exploitative. What this means is that they have no problem taking advantage of others to achieve his/her own ends. I had another patient just recently try to put my name on a complaint that they were writing to the Medical Board on another doctor. Not only did I NOT say these things, but I didn't approve of what they said. The person was willing to put my license on the line just to validate and give weight to their complaint when it was not only unnecessary, but was factually untrue. The only reason I knew about this likely was because this person knows I work with the Florida Medical Board on forensic cases and they would likely ask me about it. Another example is a patient that I have who is a sweet, caring person and her boyfriend was essentially using her for what she could provide (house, food, car) though he was cheating on her and had no problem doing that. He felt that his presence in her life warranted her continuing to provide these things without question.
• The person lacks empathy. This is a KEY symptom. They are unwilling to recognize or identify with the feelings and needs of others. The reason being is that they just don't care about you - except as an extension of them or what you can do for them. It's hard to face this, because you see this person in front of you and at times they are hurting. So, you believe that they have emotions, which they do. However, they are so self absorbed they might tell you that their sadness is due to you not providing enough support, or recognizing 'all that I do for you.' It's not a sense of sadness in a true sense of the word. This symptom typically pops out when their partner finally has had enough and tries to leave.
• They are often envious of others and/or believes that others are envious of him or her. This is a funny symptom, but it's very apparent when you are dealing with a person like this. They will usually use that phrase, "you're just jealous!" or "you will find out how much you need me when I am gone. NO ONE WILL LOVE YOU THE WAY I DO." Another good one is, "EVERYONE loves me - the problem you have with me must be YOU because YOU are the only one that I don't get along with." The hits just keep on coming with this personality disorder. Remember, when you hear this type of talk - let that be a warning.
• They display arrogant/haughty behaviors or attitudes. This is easy to spot, but it's really hard to pin on just this disorder. There are many other personality styles in this cluster that do this. Also, this symptom is in the eye of the beholder because there are many people that are insecure and may misperceive certain behaviors as haughty.

I know I'm dealing with a person with NPD - what do I do?!

Well, it depends upon the situation... First off, you need to find out for sure if they do have it. As I said earlier - there are a lot of personality styles in this cluster and they look alike and you would do something different for each one of them. If you can get them assessed - that would be good. However, as I said earlier - they don't think that anything is wrong with them and therefore they are likely going to be unwilling to be assessed.

Let's look at some basic situations...

Marriage - If you are married to someone like this then you have a problem unless you like to be run around (and some people do like this). The thing is, these people can be very sweet and make you feel on top of the world when they bring you up to their stratospheric level. However, if you displease them you are the scum of the Earth. You have to figure out what is best for you. If you have kids and you want to "work it out" for them you can get supportive therapy to just help you deal with the regular verbal abuse. But in therapy you will also likely explore what in you makes you seek someone out like that to spend your life with? It may be a link to your childhood...

Parent - Now, if you're a child or a teenager - you can't do much about this. You can recognize it and tolerate it. You will likely be a pageant baby or a sports star because this is what they want you to be. As a child, these people see you as an extension of themselves. So, you will either be what they never could be so they will be praised for your successes, though this is typically very hurtful for a child. As an adult, to deal with a parent like this is easy - you simply don't answer the phone! I know this is easier said than done, but if you have the ability to NOT be around this person it is likely in your best interest as this person will only continue to make you feel that you haven't done enough. No one likes to be told they are not good enough and shouldn't be told that.

Child - If the child has these traits and you are a parent dealing with it - you should take a good hard look in the mirror and see what in you makes your kid act that way. Either you had a parent that was Narcissistic and you are very insecure about who you are so you feel that you need to make everything perfect for this child. Or, you are trying to give your child good self esteem. Be careful what you wish for. Just because someone appears that they have good self esteem - doesn't mean they have it. In this disorder, one of the underlying causes for the disorder is an extreme LACK of self esteem. So, behaviorally, they try to build themselves up. However, to continue the hype of it all - it is a lot of work to try to be all that you have stated you are.

Coworker - You can do one of two things - you can ride on their coat tails (if you are a very behind the scenes nervous type of person), or you can steer clear. These people at work are very powerful. They seem to get things done. They are typically charismatic. However, this is a double edged sword. If you chose to ride their coat tails - it's not a free ride. You will be paying for that every day with verbal abuse. They may also throw you under the bus if they think that it will take them farther.