“It’s not what you look at that matters. It’s what you see.”     Thoreau

Narcissistic personality disorder is a mental disorder in which people have an inflated sense of their own importance, a deep need for admiration and a lack of empathy for others. But behind this mask of ultraconfidence lies a fragile self-esteem that’s vulnerable to the slightest criticism.

A narcissistic personality disorder causes problems in many areas of life… One may be generally unhappy and disappointed when not given the special favors or admiration believed to be deserved.

According to the Diagnostic & Statistical Manual of Mental Disorders, 5^th Edition (DSM-5), individuals with NPD have most or all of the following symptoms:

1. Grandiosity with expectations of superior treatment from others
2. Fixated on fantasies of power, success, intelligence, attractiveness, etc.
3. Self-perception of being unique, superior and associated with high-status people and institutions
4. Needing constant admiration from others
5. Sense of entitlement to special treatment and to obedience from others
6. Exploitative of others to achieve personal gain
7. Unwilling to empathize with others’ feelings, wishes, or needs
8. Intensely envious of others and the belief that others are equally envious of them
9. Pompous and arrogant demeanor

Characteristics of people with Narcissistic Personality Disorder are often:

• Having an exaggerated sense of self-importance

• Expecting to be recognized as superior even without achievements that warrant it

• Exaggerating achievements and talents

• Being preoccupied with fantasies about success, power, brilliance, beauty, or having the perfect mate

• Exaggerating achievements and talents

• Believing that you are superior and can only be understood by or associate with equally special people

• Requiring constant admiration

• Having a sense of entitlement

• Expecting special favors and unquestioning compliance with your expectations

• Taking advantage of others to get what you want

• Having an inability or unwillingness to recognize the needs and feelings of others

• Being envious of others and believing others envy you

• Behaving in an arrogant or haughty manner.

During my career is social work, I had many occasions to consult the Diagnostic & Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. The current edition is the fifth, and is generally called the DSM-5. There are divisions between what we generally think of as mental illnesses – thought disorders – and personality disorders. Another category of disorder is that of mood disorders, often experienced as depressed mood, with or without manic elements. Mood issues can be found in both mental illnesses and character disorders. These types of conditions are included in the DSM.

I’ve seen that some of the more bizarre manifestations of mental illness, of the thought disorder type, can sometimes be treated successfully. Medication, usually in conjunction with talk therapy, can result in dramatic improvement. Some of these results are tied to medication compliance. There is generally a significant lag in terms of time between the beginning of medical therapy and the beginning of the positive outcomes.

A hypothetical example might be someone prescribed a course of medicine. After two weeks the patient feels no better, and symptoms remain. In this case, the person continues with the meds, and starts to see improvement after, for sake of argument, the third week. This lag can be a problem in that lack of improvement after the first couple of weeks, misleads the patient to think “the pills don’t work,” and resultant discontinuation of the meds. On the other side, a patient might take the meds successfully for a year, then stop taking them. Symptoms don’t return right away, and the patient is deceived into thinking “I guess I don’t need these pills any more.” A short while later, it becomes apparent that the meds are needed, but at this point the patient may not be insightful enough to recognize the return of the symptoms.

Personality disorders are different, and can be more difficult to treat. Medication may not do much for personality disorders. The narcissistic personality disorder is named for Narcissus, the myth of the Greek youth of incredible handsomeness. He was very proud of his physical beauty. Nemesis – not a friend – lured him to a pond, where Narcissus gazed into the water, and fell in love with his own reflection. He stared at his reflection, so enraptured he could not take his eyes away. He stayed too long, staring, until he died. Narcissus’ pathological vanity and self-absorption gave rise to the name of the personality disorder.

In looking into this subject, I consulted the DSM-5, the Mayo Clinic’s website, excellent on all health matters, I conversed informally with a friend that is a psychologist, and relied upon years of experience which took me into many aspects of mental health issues. I provided sworn testimony in mental health court proceedings, executed documents and submitted reports, and interviewed hundreds of people with mental health issues, and those interacting with them.

I’ve been around a lot of mental illnesses for a lot of years, and deal with my own PTSD after my stint in the military years ago. But one needn’t be as experienced as I to spot some troubling symptoms and characteristics. While it takes a physician to diagnose, any well informed person can recognize similarities between a person’s words and actions, and established criteria.