Diagnostic definitions for Narcissistic Personality Disorders (NPDs) are important to clinicians for communicating and understanding the symptoms laid out before them through the phenomenon of the patients. Diagnostic criteria recorded in the DSM IV which is used as provisional criteria in the ICD 10 are qualitative in nature, describing 9 traits and behaviors of which 5 have to be observable in the individual in order for the individual to be diagnosed positively for the personality disorder.
When accessing the severity of the consequence of the dysfunctional behavior of the individual, the use of this criteria in the DSM falls short. This is due to the fact that the same weightage seems to be implied for all criteria while some criteria e.g. “interpersonally exploitative; takes advantage of others to achieve his or her own ends” are more destructive to society as a whole as “requires excessive admiration”. From the 2 criteria mentioned one can also see that they are interrelated.
The psychodynamic theory of personality of which a the contribution and influence of Kernberg –whose own roots are in Kleinian theory (Klein, 1957)— is well understood and cited in contemporary literature (Carveth, 2016).
Kernberg’s dimensional model for personality disorders provides a means for us to differentiate the concept of different disorders in relation to the other (Fig.1). In that diagram we can se how NPD belongs to a triad, also called the dark triad, which is continuum of severity in disruption of social function associated with the disorder. Kernberg, in his publications (Kernberg, 2008), also provides us with useful information for differentiating people/adolescents who show antisocial behaviors, if these behaviors are the result of the NPD spectrum, or if it is the result of neurotic defenses and/or social pressures of growing up – of which the latter has better prognosis.
The “dark triad” in NPD – Differentiation Summary
Antisocial Personality Disorder (APD), being the most pathological in the NPD spectrum, constitutes marked distortion, deterioration, or absence of the superego system. These patients have a syndrome of “identification with the aggressor”, and live in an internal world of violence. There is a lack of any good, reliable object relations since these individuals tend to consider the good as weak and unreliable. They respond to disappointment with rage and hatred, which is born out painful state of envy. The paranoid orientation of the APD individual makes it impossible for empathic contact with others (ibid. p. 132).
Patients with syndrome of Malignant Narcissistic Personality Disorder (MNPD) display also antisocial behaviors, paranoid traits and egosyntonic aggression directed at self and others, but without total destruction of the superego functions. The patient has and violent, grandiose self, that has the capacity to idealize significant powerful people, and can themselves depend on sadistic and powerful but reliable parental images. They therefore do have a capacity for loyalty. “Justified indignation” is the justified violence against self and others (ibid. p. 133).
Patients with NPD have the least severe form of pathological narcissism in the triad. There is a certain degree of superego evolution. There is the grandiose self, and the predominating need to protect its integrity. The patient is however able to recognize good aspects of others that they envy and want to incorporate. Antisocial behavior in these individuals reflect the egosyntonic, rationalized entitlement and greed of the grandiose self (ibid. p. 134).
NPD is something we cannot escape from, since the prevalence of the condition is not getting smaller. Societies in the industrialized world support and reward the narcissists. Those who do not meet the standards of society, ironically, end up on the antisocial end of the same spectrum. NPDs are there with us in the homes, schools and at work. Coming from Asia, I can see the development of the narcissistic character being generated in school children. There is a lot of competition for grades, and this incites envy, paranoia and distrust. In the business world, there exists bullying of executives to rake in sales at all costs—disregarding ethics or consideration for the environment. These kind of stressors wipe out an individual’s ability to empathize. Even those who do not have the personality configuration, end up having to pick up the narcissistic traits.
With this knowledge of what NPD is about, and its underlying affects of shame, guilt, greed and envy it is possible to wean sectors of society out of this trend. With the knowledge of the responsibility of the psychotherapeutic profession to facilitate change, it would be almost unethical to be ignorant on this topic.
In her book, Reaching Your Goal, Korber (2017), interview social entrepreneurs, or people whose “prime aim is to find a solution to a social problem by applying entrepreneurial tools” and who understand “the ability to act entrepreneurially and charitably at the same time, to bundle activities, create synergies or open up new knowledge, to recognize societal inequalities and reduce them efficiently (p. 16-17).” I think this describes well what ultimately society can do to reduce the prevalence of NPD.
Carveth, D. (2016). Freud & Beyond 2016 #8: Narcissism Lacan, Aichhorn, Kohut, Spotnitz, Kernberg. Abgerufen am 2017 von YouTube: https://www.youtube.com/watch?v=dGxS_5A46_4
Interdisciplinary Counsel on Developmental and Learning Disorders. (2017). Psychodynamic Diagnostic Manual PDM 2 (2nd Ausg.). (V. L. McWilliams, Hrsg.) NY: The Guilford Press.
Kernberg, O. (2008). Aggressivity, Narcissism, and Self-Destructiveness in the Psychotherapeutic Rela: New Developments in the Psychopathology and Psychotherapy of Severe Personality Disorders. Yale University Press.
Klein, M. (1957). Envy and Gratitude.
Korber, M. (2017). Reaching Your Goal. (J. Baer-Pasztory, Übers.) Vienna: BoD.