Dr Ojuolape Sapara is a UK-trained consultant psychiatrist and a member, Royal College of Psychiatrists, UK.
The specialist in general adult psychiatry and addiction or substance misuse psychiatry based in Canada, talks about narcissistic personality disorder, a mental condition whose cause is unknown but could go unnoticed for years in the sufferer.
Excerpts:
What is narcissistic personality disorder?
We all have unique personalities that are reflective of both our genetic make-up and our life experiences. This develops over the years, and is a vital part of what makes us who we are and how we interact with others. Personality disorder is a mental disorder in which one’s pervasive and enduring patterns of perceiving, reacting and relating to others cause significant distress or functional impairment.
It is usually diagnosed in early adulthood (age 18 and above) when it is clear that these traits are enduring and pervasive. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, describes narcissistic personality disorder, also known as NPD, as a pervasive pattern of grandiosity (in fantasy or behaviour), a constant need for admiration, and a lack of empathy, beginning by early adulthood and present in a variety of contexts.
It belongs to the cluster B of personality disorders, which also consists of antisocial, borderline and histrionic personality disorders, all otherwise grouped as the ‘dramatic personality disorders’.
Are there different types of NPD?
Subtypes of NPD have been described but recently, the DSM-5 has abolished these due to a lack of clinical importance.
Can the cause or causes of NPD be easily identified?
There is no specific cause for the development of personality disorders but various risk factors interplay to evolve into different personalities. These include early life experiences, learned behaviours, social environment, neurobiological factors and genetics. Individuals with personality disorders may have impaired regulation of the brain circuits that control emotion. This biological finding, when combined with psychological and adverse social factors, may contribute to a higher risk of developing a personality disorder.
What are the signs and symptoms of NPD?
Persons with NPD are characterised by a heightened sense of self-importance, lack of empathy and grandiose feeling of uniqueness. Underneath however, their self-esteem is fragile and vulnerable to even minor criticisms. They handle criticisms poorly and may become enraged when someone dares to criticise them.
They often insist on having their way, irrespective of whom or what is adversely affected in their course. Interpersonal relationship difficulties are common features. These, in addition to occupational problems, rejection and loss, are some of the stresses persons with NPD produce by their behaviour – stresses they are personally ill-equipped to cope with. Due to their fragile self-esteem, they are susceptible to depression and substance misuse disorders which are often co-morbid. In Nigeria, NPD can be observed as the ‘do-you-know-who-I-am?’ personality.
The diagnostic criteria for NPD are grandiose, a sense of self-importance, a preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love. They include a belief that one 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 admiration, sense of entitlement, interpersonally exploitive behaviour, and lack of empathy.
They also include an envy of others or a belief that others are envious of them and a demonstration of arrogant and haughty behaviours or attitudes. Individuals with a minimum of five of these nine features would meet the criteria for NPD diagnosis.
Can the disorder go unnoticed for years?
As it is with other mental health disorders, NPD can go unnoticed for many years. Most sufferers often have little or no awareness of how their actions and behaviours adversely affect others. NPD is often diagnosed when patients seek help for other co-morbid mental disorders such as substance misuse disorder, anxiety or depression.
Based on the nature of the disorder and its symptoms, is it prevalent among a particular group of people?
Lifetime prevalence of NPD is approximately six per cent. About one per cent of people are believed to be affected with NPD at some point in their lives. It is more common in men and typically affects the younger population as opposed to the older one. Many highly successful individuals display personality traits that might be considered narcissistic, particularly when these traits are inflexible, maladaptive, persistent, causing significant functional impairment and subjective distress.
Would it be correct to say that the lack of empathy for the poor or the masses in the society by many Nigerian politicians could be a strong symptom of NPD?
Lack of empathy alone is not indicative of NPD. It is present across many mental health disorders, including other cluster B personality disorders, as well as in autistic spectrum disorders.
How can NPD be easily identified in a corporate environment?
People who have excessive pride in their achievements, a relative lack of emotional display, a disdain for others’ sensitivities and an over-inflated sense of self with inflexible and maladaptive behaviours can be identified and encouraged to seek help to address these issues.
How can NPD be generally diagnosed?
It is very rare for someone to present to a doctor to complain of symptoms of NPD. NPD is often diagnosed during assessment or treatment of other mental health disorders. It is often associated with poor response to treatment of anxiety and depression and persistent poor interpersonal relation difficulties.
There are no laboratory or imaging tests used in making the diagnosis. NPD is diagnosed using a structured clinical interview, including a detailed personal history and mental state examination. Personality inventories such as personality diagnostic questionnaire – 4; millon clinical multiaxial inventory III; and international personality disorder examination, can be used for further psychological evaluation in making the diagnosis.
Are there risks to having NPD?
People with narcissistic personality disorder may have a higher risk of substance misuse and addictions behaviour, depression and anxiety disorders, low self-esteem and fear of not being good enough. They may also have a higher risk of feelings of shame, helplessness, anger at themselves, impulsive behaviour, and suicide (with lethal means).
Can the disorder be treated?
Long-term, consistent outpatient care is the approach of choice in the treatment of narcissistic personality disorder. This usually involves a combination of psychotherapy and medication management. Psychodynamic psychotherapy aimed at and addressing the patients’ sense of self, maladaptive interpersonal relationship difficulties and global functioning, has been shown to be beneficial in NPD treatment.
Other psychotherapies, including interpersonal therapy, cognitive behavioural therapy and short-term objective-focused psychotherapy are also used to treat NPD. Medications are not used specifically to treat NPD but are often used to treat concomitant anxiety, depression, impulsivity or other mood disturbances accordingly.
At what point should a person showing signs of the disorder seek help?
Persons meeting the criteria for NPD should seek help to address interpersonal relationship difficulties and/or personal distress.
Are there tips that can help a person prevent the disorder?
There are no clear preventative measures but prompt health seeking behaviour can lead to improvement in functioning and resolution of the symptoms. – Culled from Punch.
