Narcissistic Personality Disorder

Personality disorders (Axis II)

Clinicals - History

Fact Explanation
Need for admiration and other impairments in self functioning of identity. Individuals with narcissistic personality disorder (NPD) have excessive reference to others for self-definition and self-esteem regulation, their exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes and their emotional regulation mirrors fluctuations in self-esteem.
According to DSM -5 to diagnose narcissistic personality disorder, an individual must have a significant impairment in personality functioning in both self functioning and interpersonal functioning. Identity is one of the two categories in self functioning in which one of the impairments described above need to be present to diagnose NPD.
Need for admiration and other impairments in self functioning of identity.
Individuals with narcissistic personality disorder (NPD) have excessive reference to others for self-definition and self-esteem regulation, their exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes and their emotional regulation mirrors fluctuations in self-esteem.
According to DSM -5 to diagnose narcissistic personality disorder, an individual must have a significant impairment in personality functioning in both self functioning and interpersonal functioning. Identity is one of the two categories in self functioning in which one of the impairments described above need to be present to diagnose NPD.
Impairments in self-direction Because of their need for admiration, in individuals with NPD, goal-setting is based on gaining approval from others and their personal standards are unreasonably high in order of seeing oneself as exceptional, or too low based on a sense of entitlement. They are often unaware of one's own motivations.

Self direction is one of the two categories in impairment of self functioning, which is needed to diagnose NPD.
Impairments in self-direction
Because of their need for admiration, in individuals with NPD, goal-setting is based on gaining approval from others and their personal standards are unreasonably high in order of seeing oneself as exceptional, or too low based on a sense of entitlement. They are often unaware of one's own motivations.

Self direction is one of the two categories in impairment of self functioning, which is needed to diagnose NPD.
Lack of empathy Empathy is the intellectual identification with or vicarious experiencing of the feelings, thoughts, or attitudes of another.

Though Individuals with NPD are excessively attuned to
reactions of others, they have impaired ability in recognising or identifying the feelings and needs of others; as they are attentive only if subject is perceived as relevant to self and also because they tend to
over- or underestimate of own effect on others.
Lack of empathy is an impairment in interpersonal functioning, which needs to cause significant impairment of personality functioning for diagnosis of antisocial personality disorder.
Lack of empathy
Empathy is the intellectual identification with or vicarious experiencing of the feelings, thoughts, or attitudes of another.

Though Individuals with NPD are excessively attuned to
reactions of others, they have impaired ability in recognising or identifying the feelings and needs of others; as they are attentive only if subject is perceived as relevant to self and also because they tend to
over- or underestimate of own effect on others.
Lack of empathy is an impairment in interpersonal functioning, which needs to cause significant impairment of personality functioning for diagnosis of antisocial personality disorder.
Lack of intimacy Individuals with NPD hasve an Incapacity for mutually intimate relationships, as their relationships are largely superficial and exist to serve self-esteem regulation.
Relationships are mutuality constrained with little genuine interest in others' experiences and the predominance of a need for personal gain.

Lack of intimacy is an impairment in interpersonal functioning, which needs to cause significant impairment of personality functioning for diagnosis of antisocial personality disorder.
Lack of intimacy
Individuals with NPD hasve an Incapacity for mutually intimate relationships, as their relationships are largely superficial and exist to serve self-esteem regulation.
Relationships are mutuality constrained with little genuine interest in others' experiences and the predominance of a need for personal gain.

Lack of intimacy is an impairment in interpersonal functioning, which needs to cause significant impairment of personality functioning for diagnosis of antisocial personality disorder.
Grandiosity Individuals with NPD are self-centered,firmly holding to the belief that one is better than others and have feelings of entitlement, either overt or covert, leading to condescending attitudes and behaviour toward others.

It is one of the two pathological personality traits in the domain of antagonism, which is needed for a diagnosis of NPD to be made.
Grandiosity
Individuals with NPD are self-centered,firmly holding to the belief that one is better than others and have feelings of entitlement, either overt or covert, leading to condescending attitudes and behaviour toward others.

It is one of the two pathological personality traits in the domain of antagonism, which is needed for a diagnosis of NPD to be made.
Attention seeking trait Individuals with NPD make excessive attempts to be
the focus of the attention and attract others because of their admiration seeking tendencies.
Attention seeking trait
Individuals with NPD make excessive attempts to be
the focus of the attention and attract others because of their admiration seeking tendencies.

Clinicals - Examination

Fact Explanation
Mental State Examination: Appearance and Behaviour Individuals take great care in appearance because of need for admiration and exaggerated sense of self value and self importance. May tend to overdress as method of gaining admiration and due to grandiosity.
May demonstrates condescending behavior and behavior that is inappropriate to station due to sense of exaggerated self importance. Attention seeking behavior is prominent.
Mental State Examination: Appearance and Behaviour
Individuals take great care in appearance because of need for admiration and exaggerated sense of self value and self importance. May tend to overdress as method of gaining admiration and due to grandiosity.
May demonstrates condescending behavior and behavior that is inappropriate to station due to sense of exaggerated self importance. Attention seeking behavior is prominent.
Mental State Examination: Speech Speech will be coherent rational but content maybe condescending or inappropriate due to grandiosity. Mental State Examination: Speech
Speech will be coherent rational but content maybe condescending or inappropriate due to grandiosity.
Mental State Examination: Mood Mood will be euthymic,euphoric or dysphoric depending on situation as emotional regulation mirrors fluctuations in self-esteem. Mental State Examination: Mood
Mood will be euthymic,euphoric or dysphoric depending on situation as emotional regulation mirrors fluctuations in self-esteem.
Mental State Examination: Thoughts Grandiosity will be the most prominent content in thought. No abnormalities in form of thought will be present. Mental State Examination: Thoughts
Grandiosity will be the most prominent content in thought. No abnormalities in form of thought will be present.
Mental State Examination: Perception No perceptual abnormalities are associated with antisocial personality disorder. Mental State Examination: Perception
No perceptual abnormalities are associated with antisocial personality disorder.
Mental State Examination: Cognitive functions Orientation,attention,concentration and memory will be within normal range. Mental State Examination: Cognitive functions
Orientation,attention,concentration and memory will be within normal range.
Insight Will often not accept the presence of a disorder or need for treatment. Insight
Will often not accept the presence of a disorder or need for treatment.

Management - Supportive

Fact Explanation
Develop a successful relationship among patient and psychiatrist/therapist. As insight is poor and treatment is often refused by patients with personality disorders building up an effective therapeutic relationship is crucial as the first step of management. Develop a successful relationship among patient and psychiatrist/therapist.
As insight is poor and treatment is often refused by patients with personality disorders building up an effective therapeutic relationship is crucial as the first step of management.
Insight oriented approach Poor insight is one of the main barriers to treatment, therefore building insight is essential in treating personality disorders. Insight oriented approach
Poor insight is one of the main barriers to treatment, therefore building insight is essential in treating personality disorders.
treatment of coexistent psychiatric symptoms antidepressants,mood stabilizers and antipsychotic drugs are sometimes prescribed in the management of individuals with Narcissistic personality disorder ,who have prominent symptoms of other psychiatric disorders. treatment of coexistent psychiatric symptoms
antidepressants,mood stabilizers and antipsychotic drugs are sometimes prescribed in the management of individuals with Narcissistic personality disorder ,who have prominent symptoms of other psychiatric disorders.

Management - Specific

Fact Explanation
psychotherapy Psychodynamic psychotherapy and short-term objective-focused psychotherapy is used in treatment of personality disorders. psychotherapy
Psychodynamic psychotherapy and short-term objective-focused psychotherapy is used in treatment of personality disorders.
cognitive behavioral therapy Cognitive and behavioral interventions include reasoning and rehabilitation and enhanced thinking skills. Cognitive therapy maybe as effective as psychotherapy in the treatment of personality disorders. cognitive behavioral therapy
Cognitive and behavioral interventions include reasoning and rehabilitation and enhanced thinking skills. Cognitive therapy maybe as effective as psychotherapy in the treatment of personality disorders.
Training in social skills and problem solving When combined with cognitive behavioral interventions, has a high efficacy. Training in social skills and problem solving
When combined with cognitive behavioral interventions, has a high efficacy.

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