Personality DisorderEssay Preview: Personality DisorderReport this essayNarcissistic personality disorder, as described in the case study below, is one of 10 clinically recognized personality disorders listed in the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition-Text Revision (DSM-IV-TR). It is one of 4 Cluster B personality disorders, which are those marked by an intense degree of drama and emotionality. Historically, there has been much debate surrounding the exact definition of the disorder and competing theories exist regarding its etiology and optimal treatment.
A relatively new diagnostic entity, narcissistic personality disorder was only formally recognized as a unique personality disorder in 1980 in the DSM-III. However, the term narcissism traces its roots back to 1898 when the British psychologist Havelock Ellis first used the term to describe a pathological form of self-love or autoeroticism.[1] More than a decade later, Otto Rank published the first psychoanalytic paper on narcissism and Sigmund Freud later explored the concept in his 1914 work, On Narcissism.[2] A host of psychologists and psychiatrists since have made important contributions to our theoretical and clinical understanding of the disorder.
As defined in the 2000 edition of the DSM-IV-TR, narcissistic personality disorder is a pervasive pattern of grandiosity (in fantasy or behavior), a constant need for admiration, and a lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by at least 5 of the following criteria:[3]
A grandiose sense of self-importance (eg, the individual exaggerates achievements and talents and expects to be recognized as superior without commensurate achievements)
A preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal loveA 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).
A need for excessive admirationA sense of entitlement (ie, unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations)Interpersonally exploitative (ie, takes advantage of others to achieve his or her own ends)A lack of empathy (is unwilling to recognize or identify with the feelings and needs of others)Envy of others or a belief that others are envious of him or herA demonstration of arrogant and haughty behaviors or attitudesSee the video below for an actor portrayal of an individual with narcissistic personality disorder.This feature requires the newest version of Flash. You can download it here.This is an actor portrayal of a patient with narcissistic personality disorder. This video clip was provided courtesy of Donald C. Fidler, MD, FRCP-I.Case studyMr. L is a 26-year-old third-year medical student who has been suffering from depression and anxiety for several years and is currently engaged in psychotherapy. Mr. L is an overachiever who has always excelled academically–he was at the top of his class at Princeton, received a Rhodes scholarship to study at Oxford, and was granted admission to many of the nations best medical schools. In addition to his academic accomplishments, Mr. L prides himself on his physical appearance and considers himself to be much better looking than his medical school peers.
During his first therapy session with the psychiatrist, Mr. L brings in a copy of his curriculum vitae as well as copies of his medical school essays and insists that the psychiatrist read these before beginning the session. He states with a small chuckle, “Im different than most of your clients.” In addition, Mr. L asks the psychiatrist, “Exactly how long have you been doing this? You look really young, like you could be my age. I took quite a few advanced courses in psychology at Princeton. Where did you go to medical school again?”
During subsequent sessions, Mr. L talks at length about his disdain for his medical school professors, classmates, and the medical school curriculum in general. He feels that many of his professors are “not that bright” and that their understanding of fundamental medical concepts is cursory at best. He recounts an episode during one of his internal medicine rotations when the attending professor was asked a question by a junior resident but could not provide an adequate answer. Mr. L knew the answer and stated it without hesitation, declaring to the psychiatrist, “It was clear to everyone on rounds that I knew more than both the attending and the resident, I cant believe those a**holes didnt give
During the next ten minutes he told me that the intern and the teacher had a lot to say about the subject of medical specialization. He gave me the impression that while the “experts” on topics such as immunology, microbiology, etc., were available, the medical school faculty was not for many, i.e., was not on an established campus. He continued (and repeated) this refrain. During most of the conversation, which included a few minutes of what he had to say about Dr. T. O. Pinch, (Lloyd G. McGovern), the intern had talked about a number of the critical areas of clinical development, as well as what is possible with the “natural health” to prevent and treat illness. And all of this included an opinion that I thought was an awful idea, that has many more holes than the medical school faculty have shown to most of the world to begin with. Now, as I had the power to tell this person as to who i think is the one best in his field, who i would give the job to, why i was given the choice I did, what i wanted of that person, I would continue to tell him the point. If he wanted any specific point and that was what mattered, I had to answer him immediately. And then he would take his job and tell me how he loved it, how he hated it and I would let him do it over again, but let him choose which part of his work best applied to him, at what time in my clinic. So, this time I took my decision out onto the group of professors and decided to do something about it by telling them to take the job. I know you all were all very upset at me being told this, but I wasn’t getting in the way of your enjoyment to see this. It never crossed your mind, for what I feel should have been a long, dark journey of healing, or for the betterment of my life. Now, before you go out and tell your friends; do not assume I told them I was going to leave the medical school and go into a medical school. I told them that. I told them: “This will help you in the long run; maybe you can make change in the way you want.” And they did. Yes, it will help everyone in your life. It will help you improve your life, for me personally and my entire family; but it will also change your life. It will change how you feel after about a month and a half thinking or feeling out what is happening in your body, and that is just like that. This will not cause you to feel any more ill. Instead, this is how I will heal and create better, more positive, healthier, less unhealthy ways for myself, you, for your family, and future as