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narcissistic personality disorder
A syndrome of grandiosity, need for admiration, lack of empathy.
Epidemiology:
- generally begins in early adulthood
Clinical manifestations:
- pervasive sense of entitlement, grandiosity & arrogance
- lack of empathy
- disturbances in emotionality, cognition, interpersonal functioning, & impulse control that cause significant distress or impaired functioning [2]
- patients tend to exaggerate achievements & seek admiration [2]
- elderly: may become hostile, paranoid or depressed
Diagnosis:
requires 5 or more of the following)
1) grandiose sense of self-importance
a) exaggerates achievements & talents
b) expects to be recognized as superior without commensurate achievements
2) preoccupation with fantasies of limited success
3) belief that he/she is special & unique & can only be understood by, or should associate with, other special or high-status people (or institutions)
4) needs excessive admiration
5) has a sense of entitlement
- unreasonable expectations of
- favorable treatment
- compliance with his/her expectations
6) interpersonally exploitive: takes advantage of others to achieve his/her own ends
7) lacks empathy: unwilling to recognize the feelings & need of others
8) often envious of others or believes that others are envious of him/her
9) arrogant
Differential diagnosis:
- histrionic personality disorder
- no inflated sense of self-importance or entitlement [2]
Management:
- assess for & treat mood lability, depression, anxiety, substance abuse
- consistent, structured approach with well-defined boundaries to contain unacceptable behaviors
- team approach with a common plan (teamwork)
- behavioral contracts to address recurrent unacceptable behaviors
- resort to higher level of care if management ineffective
- do not personalize aggressive behavior directed towards staff
- allow staff opportunities to vent
Related
narcissism
General
cluster B personality disorder
References
- Diagnostic and Statistical Manual of Mental Disorders, 4th ed.,
Text Revision, DSM-IV-TR, American Psychiatric Association,
Washington DC, 2000
- Geriatrics Review Syllabus, American Geriatrics Society,
5th edition, 2002-2004;
- Geriatric Review Syllabus, 11th edition (GRS11)
Harper GM, Lyons WL, Potter JF (eds)
American Geriatrics Society, 2022
- Kacel EL, Ennis N, Pereira DB.
Narcissistic personality disorder in clinical health psychology practice:
case studies of comorbid psychological distress and life-limiting illness.
Behav Med. 2017;43(3):156-164
PMID: 28767013 PMCID: PMC5819598 Free PMC article
https://www.tandfonline.com/doi/abs/10.1080/08964289.2017.1301875