Cluster B: Narcissistic PD

Question 1

Pervasive pattern of:

Answer 1

• Grandiosity (fantasy or real life)
• Need for admiration
• Lack of empathy

Question 2

Criteria

Answer 2

5 or more of
* Grandiose sense of self-importance
* Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
* Believes they’re special and unique, can only be understood by other special or high-status people
* Requires excessive admiration
* Sense of entitlement
* Interpersonally exploitative
* Lacks empathy
* Is often envious of others
* Arrogant or haughty behaviors or attitudes

Question 3

Associated features

Answer 3

• Very sensitive to criticism –> will rumminate
• Leads to impairment socially and at work
• May react with disdain or rage
• Social withdrawal or an apperance of humility that may mark the grandiosity
• Interpersonal relations are usually strained
• Tough ambitious and confident with high achievements, performance may be disrupted due to intolerance of criticism
• Not usually risky individual
• usually associated with anorexia nervosa and substance use disorder

Question 4

Prevalence and gender

Answer 4

• 0-6.2% (large range)
• Much more common in males (50-75% are male)

Question 5

Developemental and course

Answer 5

• May be common in adolescents and do not necessarily indicate that the individual will go on to have narcissistic PD
• special difficulties adjusting to the onset of physical and occupation limitations that are inherent in the aging process

Question 6

Differential diagnosis

Answer 6

• Histrionic PD: More emotional and flirtatious; NPD is more proud, less emotional, and shows little concern for others’ feelings
• Borderline PD: Borderline has unstable self-image, self-harm, and fears of abandoment while NPD is more stable and less self-destructive
• Antisocial PD: Both can be charming, lack empathy, and exploit others. ASPD is more aggressive, impulsive, deceitful, and linked to criminal behavior, NPD usually isn’t. NPD craves admiration and envy, ASPD seeks power or gain
• Obsessive-compulsive PD: Both may seek perfection and believe others are incompetent. NPD sees themselves as already perfect, OCPD is self-critical
• Schizotypal and Paranoid PD: Show social withdrawal and suspicion. NPD may avoid vulnerability, but still seek admiration, not isolation
• Mania/Hypomania: grandiosity can occur but is short-term and mood related, unlike the stable trait in NPD
• High functioning individuals: Confidence and perfectionism can look narcissitic but arent pathological without impairment