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This redirect is about the psychiatric condition of narcissism. For narcissism in the generic sense, see Narcissism.

Narcissus, the Greek hero after whom narcissism is named, became obsessed with his own reflection.

The term narcissism means love of oneself, and refers to the set of character traits concerned with self-admiration, self-centeredness and self-regard. The name was chosen by Sigmund Freud, from the Greek myth of Narcissus, who was doomed to fall in love with his own reflection in a pool of water.

While almost everyone is narcissistic to some degree, certain forms of narcissism can be highly dysfunctional, and are classified as pathologies such as the Narcissistic Personality Disorder and malignant narcissism. Psychopathy, as defined by the PCL-R, also contains a narcissistic factor .

Narcissism as defined by Psychiatry

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Narcissism is a term first used in relation to human thought and behavior by the Austrian physician and psychiatrist Sigmund Freud.

Narcissism is a set of character traits concerned with self-admiration, self-centeredness and self-regard.

Everyone has some narcissistic traits. However, narcissism can also manifest in an extreme pathological form in some personality disorders such as Narcissistic Personality Disorder wherein the patient overestimates his abilities and has an excessive need for admiration and affirmation. This may be present to such a degree that it severely damages the person's ability to live a productive or happy life because the traits manifest as severe selfishness and disregard for the needs and feelings of others.

In The Beginning - The Psychoanalysts

Freud

File:Sigmund Freud-loc.jpg

Sigmund Freud

Main article: Sigmund Freud

The Austrian physician Sigmund Freud (1856-1939), a neurologist turned psychiatrist, introduced the concept of narcissism in his 1914 essay On Narcissism: An Introduction,.

The Freudian Theory of Narcissism

Primary narcissism

In his essay, 'On Narcissism: An Introduction', Freud suggested that exclusive self-love might not be as abnormal as previously thought, and might even be a common component in the human psyche. He argued that narcissism "is the libidinal compliment to the egoism of the instinct of self-preservation", or, more simply, the desire and energy that drives our instinct to survive. He called this: Primary Narcissism.

According to Freud we are not born with a sense of ourselves as individuals, or ego. The ego only develops during infancy and the early part of childhood, as the outside world, usually in the form of parental controls and expectations, intrudes upon primary narcissism, teaching the individual about the nature and standards of his social environment from which he can form the ideal ego, an image of the perfect self towards which the ego should aspire.

Freud regarded all libidinous drives as fundamentally sexual and suggested that ego libido (libido directed inwards to the self) cannot always be clearly distinguished from object-libido (libido directed to persons or objects outside of ourselves).

An aspect frequently associated with Primary Narcissism appears in an earlier essay, 'Totem and Taboo'. where he describes his observations of children and primitive people, which he called "magical thinking". An example of magical thinking would be believing that you can have an effect on reality by wishing or willpower. This demonstrates a belief in the self as powerful and able to change external realities, which Freud believed was part of normal human development.

Secondary narcissism

According to Freud, secondary narcissism is a pathological condition which occurs when the libido withdraws from objects outside of the self. Freud further claimed that it is an extreme form of the narcissism that is part of all of us.

Narcissism, relationships and self worth

According to Freud, to care for someone is to convert ego-libido into object-libido by giving some self-love to another person, which leaves less ego-libido available for primary narcissism and protecting and nurturing the self. When that affection is returned so is the libido, thus restoring primary narcissism and self worth. Any failure to achieve, or disruption of, this balance causes psychological disturbances. In such a case primary narcissism can only be restored by withdrawing object-libido (also called, object-love), to replenish ego-libido.

According to Freud, as a child grows, and his ego develops, he is constantly giving of his self-love to people and objects, the first of which is usually his mother. This diminished self-love should be replenished by the affection and caring returned to him.

Karen Horney

Main article: Karen Horney

German physician and psychiatrist Karen Horney (1885-1952) began to develop her own theory of psychoanalysis in the late 1930s. Though acknowledging Freud as the founder of psychoanalysis, she was critical of his work, arguing that personality was shaped mainly by social, cultural, and environmental factors. She felt that Freud was wrong to assume that the relationships, attitudes, and feelings common in his culture and times were largely driven by biological factors and could be applied universally.

Horney saw narcissism quite differently from Freud, Kohut, and other mainstream psychoanalytic theorists in that she did not posit a primary narcissism but saw the narcissistic personality as the product of a certain kind of early environment acting on a certain kind of temperament. For her, narcissistic needs and tendencies are not inherent in human nature.

Narcissism is different from her other major defensive strategies or solutions in that it is not compensatory. Self-idealization is compensatory in her theory, but it differs from narcissism. All of the defensive strategies involve self-idealization, but in the narcissistic solution it tends to be the product of indulgence rather than of deprivation. The narcissist's self-esteem is shaky, however, because it is not based on genuine accomplishments.

Heinz Kohut

Main article: Heinz Kohut

Viennese physician and psychiatrist Heinz Kohut, M.D. (1913 - 1981) is best known for his development of Self Psychology, a school of thought within psychodynamic/psychoanalytic theory.

Kohut explored further the implications of Freud's perception of narcissism.

He said that a child will tend to fantasize about having a grandiose self and ideal parents. He claimed that deep down we all retain a belief in our own perfection, and the perfection of anything we are part of, as we mature, grandiosity gives way to self-esteem, and the idealization of the parent become the framework for core values. It is when trauma disrupts this process that the most primitive and narcissistic version of the self remains unchanged. Kohut called this condition Narcissistic Personality Disorder.

He suggested narcissism as part of a stage in normal development, in which caregivers provide a strong and protective presence for the child to identify with that reinforces the child's growing sense of self by mirroring his good qualities. If the caregivers fail to provide this adequately, the child grows up with a brittle and flawed sense of self.

He also saw beyond the negative and pathological aspects of narcissism, believing it to be a component in the development of resilience, ideals and ambition once it has been transformed by life experiences or analysis.

Otto Kernberg

Main article: Otto Kernberg

Otto Kernberg uses the term Narcissism to refer to the role of self in the regulation of self esteem.

He regarded normal, infantile Narcissism to be dependent on the affirmation of others and the acquisition of desirable and appealing objects, which should later develop into healthy, mature, self-esteem. This healthy Narcissism depends upon an integrated sense of self that incorporates images of the internalised affirmation of those close to us, that is regulated by the super ego and ego ideal, internal mental structures that assure us of our worth and that we deserve our own respect.

When infantile Narcissism fails to develop in this healthy adult form, it becomes a pathology.

Other forms of narcissism

Acquired situational narcissism

Acquired Situational Narcissism is a form of narcissism that develops in late adolescence or adulthood, brought on by wealth, fame and the other trappings of celebrity. It was coined by Robert B. Millman, professor of psychiatry at the Weill Medical College of Cornell University.

ASN differs from conventional narcissism in that it develops after childhood and is triggered and supported by the celebrity-obsessed society: fans, assistants and tabloid media all play into the idea that the person really is vastly more important than other people, triggering a narcissistic problem that might have been only a tendency, or latent, and helping it to become a full-blown personality disorder.

In its presentation and symptoms, it is indistinguishable from Narcissistic Personality Disorder, differing only in its late onset and its support by large numbers of others. The person with ASN may suffer from unstable relationships, substance abuse and erratic behaviour.

A famous fictional character with ASN is Norma Desmond, the main character of Sunset Boulevard.

Ironically, as his reputation grew, Dr. Millman developed ASN himself and suffered from many of its symptoms.

Sexual narcissism

Sexual narcissism is the erotic preoccupation with oneself as a sexual being: a desire to merge sexually with a mirror image of oneself. Sexual narcissism can also be an egocentric pattern of sexual behavior, defined by David Farley Hurlbert and Carol Apt as an inability to experience intimacy combined with a fixation on the sexual act, using high sexual esteem to compensate for low general self esteem. This is believed to be more common in men than in women and is suggested to be the basis of sex addiction.

Narcissistic style

Johnson discusses Narcissism as constituting a spectrum, from a severe disorder with much in common with borderline personality disorder, to a much less severe, high-functioning form he calls "the narcissistic style."

"People who have a narcissistic personality style rather than narcissistic personality disorder are relatively psychologically healthy, but may at times be arrogant, proud, shrewd, confident, self-centered and determined to be at the top. They may not, however, have an unrealistic image of their skills and worth and are not so strongly dependent on praise to sustain a healthy self-esteem."

Disordered narcissism

Main article: Narcissistic personality disorder

Lack of empathy is a hallmark of narcissistic disorders, and sufferers find it extremely difficult to understand others' (and their own) emotional states and impact. This poses serious problems in maintaining close or intimate relationships. They may find it difficult to perceive or admit this flaw, or may reinterpret it as a virtue.

It is also worth noting that the individual expressions of grandiosity or arrogance vary with the person's value system. A person will generally attempt to display superiority as they define it.

Overreacts to criticism, becoming angry or humiliated
Uses others to reach goals
Exaggerates own importance
Entertains unrealistic fantasies about achievements, power, beauty, intelligence or romance
Has unreasonable expectations of favorable treatment
Seeks constant attention and positive reinforcement from others
Is easily jealous
Has a sense of entitlement
Is interpersonally exploitative
Lacks empathy
Displays arrogant behavior
Displays haughty behavior

Commonly used measures of narcissism

Narcissistic Personality Inventory

The Narcissistic Personality Inventory (NPI) is the most widely used measure of narcissism in social psychological research. Although several versions of the NPI have been proposed in the literature, a 40-item forced-choice version (Raskin & Terry, 1988) is the one most commonly employed in current research. The NPI is based on the DSM-III clinical criteria for Narcissistic Personality Disorder (NPD), although it was designed to measure these features in the general population. Thus, the NPI is often said to measure "normal" or "sub-clinical" narcissism (i.e., people who score very high on the NPI do not necessarily meet criteria for diagnosis with NPD).

Because the NPI was originally based on DSM criteria for NPD, there has been much research on its factor structure. Raskin and Terry (1988) identified seven factors of the NPI (i.e., superiority, exhibitionism, entitlement, vanity, authority, exploitativeness and self-sufficiency), mapping roughly onto the DSM criteria for NPD. Since then, several studies have further examined the factor structure of the NPI with varying results. For example, some studies report three factors, some report 4 factors. Furthermore, it is often the case that factors of the NPI exhibit very low internal consistency (although the full scale exhibits acceptable reliability). Thus, it may currently be concluded that the factor structure of the NPI is unknown.

Research has found that people who score high on the NPI are more likely to: cheat and game-play in relationships; take more resources for themselves and leave less for others; value material things; like looking at themselves in the mirror. NPI scores are higher in recent generations.

The MCMI

The Millon Clinical Multiaxial Inventory (MCMI) is a widely-used diagnostic test developed by Theodore Millon. The MCMI includes a scale for Narcissism. Auerbach JS ("Validation of two scales for narcissistic personality disorder", J Pers Assess. 1984 Dec;48(6):649-53. ) compared the NPI and MCMI, and found them well correlated, r(146) = .55, p<.001. However, it should be noted that whereas the MCMI measures Narcissistic Personality Disorder (NPD), the NPI measures narcissism as it occurs in the general population. In other words, the NPI measures "normal" narcissism; i.e., most people who score very high on the NPI do not have NPD. Indeed, the NPI does not capture any sort of narcissism taxon as would be expected if it measured NPD.

Heritability of narcissism utilizing twin studies

Livesley et al. (1993) published a paper entitled Genetic and environmental contributions to dimensions of personality disorder, which concluded, in agreement with other studies, that narcissism as measured by a standardized test was a common inherited trait. Additionally, in similar agreement with those other studies, it was found that there exists a continuum between normal and disordered personality.

The study subjects were 175 volunteer twin pairs (90 identical, 85 fraternal) drawn from the general population. Each twin completed a questionnaire that assessed 18 dimensions of personality disorder. The authors estimated the heritability of each dimension of personality by standard methods, thus providing estimates of the relative contributions of genetic and environmental causation.

Of the 18 personality dimensions, narcissism was found to have the highest heritability (0.64), indicating that the concordance of this trait in the identical twins was significantly influenced by genetics. Of the other dimensions of personality, only four were found to have heritability coefficients of greater than 0.5: callousness, identity problems, oppositionality and social avoidance.

The study generally concluded that, in agreement with other studies, some personality factors have significantly high heritability coefficients, and there exists a continuum between normal and disordered personality.

References

Nestor, Paul G Mental Disorder and Violence: Personality Dimensions and Clinical Features The American Journal of Psychiatry, 2002; 159:1973–1978
Freud, Sigmund, On Narcissism: An Introduction, 1914
Freud, Sigmund, Totem and Taboo, 1913
Paris, Bernard J, Personality and Personal Growth, edited by Robert Frager and James Fadiman, 1998
Kohut, Heinz, The Analysis of the Self, 1971
Kohut, Heinz, Forms and Transformations of Narcissism, 1966
Siniscalco, Raffaele Narcissism. The american contribution - a conversation with Otto Kernberg Journal of European Psychoanalysis, Number 12-13 - Winter-Fall 2001
Hurlbert, D.F., Apt, C., Sexual narcissism and the abusive male.
Stephen M. JohnsonHumanizing the Narcissistic Styl, 1987, W. W. Norton and Company, isbn0-393-70037-2
Narcissistic personality disorder: Signs and symptoms - MayoClinic.com
Laura Stephens (2006). "Narcissistic Personality Disorder". Psychology Today's Diagnosis Dictionary. Psychology Today. Retrieved 2007-02-14. {{cite web}}: Unknown parameter |month= ignored (help)
Foster, J.D., & Campbell, W.K., Are there such things as "narcissists" in social psychology? A taxometric analysis of the Narcissistic Personality Inventory. Personality and Individual Differences, in press.
Livesley, W.J., Jang, K.L., Jackson, D.N. and P.A. Vernon (1993). "Genetic and environmental contributions to dimensions of personality disorder". American Journal of Psychiatry 150, 1826-1831. Abstract online. Accessed June 18, 2006.

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