Narcissistic personality disorder
|Narcissistic Personality Disorder|
|Classification and external resources|
|Cluster A (odd)|
|Cluster B (dramatic)|
|Cluster C (anxious)|
Narcissistic Personality Disorder (NPD) is a personality disorder in which a person is excessively preoccupied with personal adequacy, power, prestige and vanity, mentally unable to see the destructive damage they are causing to themselves and to others in the process. It is estimated that this condition affects one percent of the population. First formulated in 1968, NPD was historically called megalomania, and is a form of severe egocentrism.
People who are diagnosed with a narcissistic personality disorder are characterized by exaggerated feelings of self-importance. They have a sense of entitlement and demonstrate grandiosity in their beliefs and behavior. They have a strong need for admiration, but lack feelings of empathy.
- Expects to be recognized as superior and special, without superior accomplishments
- Expects constant attention, admiration and positive reinforcement from others
- Envies others and believes others envy him/her
- Is preoccupied with thoughts and fantasies of great success, enormous attractiveness, power, intelligence
- Lacks the ability to empathize with the feelings or desires of others
- Is arrogant in attitudes and behavior
- Has expectations of special treatment that are unrealistic
Other symptoms in addition to the ones defined by DSM-IV-TR include: Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends, has trouble keeping healthy relationships with others, easily hurt or rejected, appears unemotional, and exaggerating special achievements and talents, setting unrealistic goals for himself/herself.
Narcissistic Personality Disorder is characterized by an over-inflated sense of self-importance, as well as dramatic, emotional behavior that is in the same category as antisocial and borderline personality disorders. 
In addition to these symptoms, the person may display arrogance, show superiority, and seek power. The symptoms of narcissistic personality disorder can be similar to the traits of individuals with strong self-esteem and confidence; differentiation occurs when the underlying psychological structures of these traits are considered pathological. Narcissists have such an elevated sense of self-worth that they value themselves as inherently better than others, when in reality they have a fragile self-esteem, cannot handle criticism, and often try to compensate for this inner fragility by belittling or disparaging others in an attempt to validate their own self-worth. Comments and criticisms about others are vicious from sufferers of NPD, in an attempt to boost their own poor self-esteem.
Another narcissist symptom is a lack of empathy. They are unable to relate, understand, and rationalize the feelings of others. Instead of behaving in a way that shows how they are feeling in the moment, they behave in the way that they feel they are expected to behave or what gives them the most attention.
In children, inflated self-views and grandiose feelings, which are characteristics of narcissism, are part of the normal self-development. Children typically cannot understand the difference between their actual and their ideal self, which causes an unrealistic perception of the self. After about age 8, views of the self, both positive and negative, begin to develop based on comparisons of peers, and become more realistic. Two factors that cause self-view to remain unrealistic are dysfunctional interactions with parents that can be either excessive attention or a lack thereof. For example but not limited to, the excessive attention and lack of attention go hand in hand when a child’s parents are divorced. Usually, one is overindulgent (typically the one seeing the child less) and the other shows less affection. The child either compensates for lack of attention or acts in terms of unrealistic self-perception.
An extensive US survey found a high association with other disabilities, especially amongst men: mental disability, substance use, mood, anxiety disorders and other personality disorders, bipolar I disorder, post-traumatic stress disorder, and schizotypal and borderline personality disorders were among the associated disabilities.
The study of Narcissism and the Narcissistic Defenses in the Eating Disorders was concerned with the correlation between eating pathology and narcissism. Two types of narcissism were observed: core narcissism, having extremely positive (high) self-esteem combined with delusions about the level and ability of achievement; and narcissistic defenses, defenses that are triggered when self-esteem is threatened. Such narcissists maintain self-esteem by seeing themselves as misunderstood and a subject to intolerable demands.
Two types of narcissistic defenses that were measured with eating pathology were "poisonous pedagogy" and "narcissistically abused". Poisonous pedagogy is one who places blame on others and is overly critical of others' inadequacies. The narcissistically abused are those who put others’ needs before theirs yet see themselves as being poorly treated. Two groups were measured: Clinical (83 women and one male with the mean age of 28.4) and Non Clinical (70 women mean age of 23.2). BMI of groups did not significantly vary. They filled out a questionnaire that was measured by eating characteristic and narcissism levels by the OMNI (O’Brien Multiphasic Narcissism Inventory) and the EDE-Q (Eating Disorder Examination Questionnaire). OMNI measures pathological narcissism of narcissistic personality, poisonous pedagogy, and narcissistically abused personality. EDE-Q measures the common eating disorders: restraint, eating concern, body shape concern, and body weight concern.
The basic summaries of the questionnaire’s findings were the poisonous pedagogy defenses was related to restrictive mind-set; narcissistically abused defense related to restraint, eating concern, body shape concern, and body weight concern. The only main difference between the groups was the role of core narcissism in the clinical women’s levels of eating concerns. Further research is needed to better understand the relationship approaches in both groups.
In 2005, Board and Fritzon published the results of a study in which they interviewed senior business managers, assessing them for the presence of personality disorder. Comparing their findings to three samples of psychiatric patients, they found that their senior business managers were as likely to demonstrate narcissistic traits as the patient population, although were less physically aggressive.
The cause of this disorder is unknown; however, Groopman and Cooper (2006) listed the following factors identified by various researchers as possibilities:
- An oversensitive temperament (personality traits) at birth.
- Excessive admiration that is never balanced with realistic feedback.
- Excessive praise for good behaviors or excessive criticism for bad behaviors in childhood.
- Overindulgence and overvaluation by parents, other family members, or peers.
- Being praised for perceived exceptional looks or abilities by adults.
- Severe emotional abuse in childhood.
- Unpredictable or unreliable caregiving from parents.
- Learning manipulative behaviors from parents.
- Valued by parents as a means to regulate their own self-esteem.
Some narcissistic traits are common with a normal developmental phase. When these traits are compounded by a failure of the interpersonal environment and continue into adulthood, they may intensify to the point where NPD is diagnosed.
Recent research has identified a structural abnormality in the brains of those with narcissistic personality disorder, specifically noting less volume of gray matter in the left anterior insula. This brain region relates to empathy, compassion, emotional regulation, and cognitive functioning.
Pathological narcissism occurs in a spectrum of severity. In its more extreme forms, it is narcissistic personality disorder (NPD). NPD is considered to result from a person's belief that they are flawed in a way that makes them fundamentally unacceptable to others. This belief is held below the person's conscious awareness; such a person would, if questioned, typically deny thinking such a thing. To protect themselves against the intolerably painful rejection and isolation that (they imagine) would follow if others recognized their (perceived) defective nature, such people make strong attempts to control others’ views of them and behavior towards them.
Pathological narcissism can develop from an impairment in the quality of the person's relationship with their primary caregivers, usually their parents, in that the parents could not form a healthy and empathic attachment to them. This results in the child's perception of himself/herself as unimportant and unconnected to others. The child typically comes to believe they have some personality defect that makes them unvalued and unwanted.
To the extent that people are pathologically narcissistic, they can be controlling, blaming, self-absorbed, intolerant of others’ views, unaware of others' needs and of the effects of their behavior on others, and insistent that others see them as they wish to be seen.
Narcissistic individuals use various strategies to protect the self at the expense of others. They tend to devalue, derogate and blame others, and they respond to threatening feedback with anger and hostility.
People who are narcissistic commonly feel rejected, humiliated and threatened when criticised. To protect themselves from these dangers, they often react with disdain, rage, and/or defiance to any slight criticism, real or imagined. To avoid such situations, some narcissistic people withdraw socially and may feign modesty or humility. In cases where the narcissistic personality-disordered individual feels a lack of admiration, adulation, attention and affirmation, they may also manifest a desire to be feared and be notorious (narcissistic supply).
Although individuals with NPD are often ambitious and capable, the inability to tolerate setbacks, disagreements or criticism, along with lack of empathy, make it difficult for such individuals to work cooperatively with others or to maintain long-term professional achievements. With narcissistic personality disorder, the individual's self-perceived fantastic grandiosity, often coupled with a hypomanic mood, is typically not commensurate with his or her real accomplishments.
People who are diagnosed with narcissistic personality disorder use splitting as a central defense mechanism. According to psychoanalyst Kernberg, "The normal tension between actual self on the one hand, and ideal object on the other, is eliminated by the building up of an inflated self-concept within which the actual self and the ideal self and ideal object are confused. At the same time, the remnants of the unacceptable images are repressed and projected onto external objects, which are devalued."
The merging of the "inflated self-concept" and the "actual self" is seen in the inherent grandiosity of narcissistic personality disorder. Also inherent in this process are the defense mechanisms of devaluation, idealization and denial. Other people are either manipulated as an extension of one's own self, who serve the sole role of giving "admiration and approval" or they are seen as worthless (because they cannot collude with the narcissist's grandiosity).
Relationship to shame
It has been suggested that narcissistic personality disorder may be related to defenses against shame. Psychiatrist Glen Gabbard suggested NPD could be broken down into two subtypes. He saw the "oblivious" subtype as being grandiose, arrogant, and thick-skinned, and the "hypervigilant" subtype as being easily hurt, oversensitive, and ashamed. In his view, the oblivious subtype presents for admiration, envy, and appreciation of a powerful, grandiose self that is the antithesis of a weak internalized self, which hides in shame, while the hypervigilant subtype neutralizes devaluation by seeing others as unjust abusers. Dr. Jeffrey Young, who coined the term "Schema Therapy", a technique originally developed by psychiatrist Aaron T. Beck (1979), also links NPD and shame. He sees the so-called Defectiveness Schema as a core schema of NPD, along with the Emotional Deprivation and Entitlement Schemas.
The formulation of narcissistic personality disorder in DSM-IV was criticised for failing to describe the range and complexity of the disorder. Critics say it focuses overly on "the narcissistic individual's external, symptomatic, or social interpersonal patterns—at the expense of ... internal complexity and individual suffering," which reduces its clinical utility.
The Personality and Personality Disorders Work Group originally proposed the elimination of NPD as a distinct disorder in DSM-5 as part of a major revamping of the diagnostic criteria for personality disorders, replacing a categorical with a dimensional approach based on the severity of dysfunctional personality trait domains.
Some clinicians objected to this, characterizing the new diagnostic system as an "unwieldy conglomeration of disparate models that cannot happily coexist" and may have limited usefulness in clinical practice.
In July 2011, the Work Group came back with a major revision to their original proposal. In this revision, NPD was reinstated with dramatic changes to its definition. The general move towards a dimensional (personality trait-based) view of the Personality Disorders has been maintained despite the reintroduction of NPD.
It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.
|Unprincipled narcissist||Including antisocial features. A charlatan who is a fraudulent, exploitative, deceptive, and unscrupulous individual||Deficient conscience; unscrupulous, amoral, disloyal, fraudulent, deceptive, arrogant, exploitive; a con man and charlatan; dominating, contemptuous, vindictive.|
|Amorous narcissist||Including histrionic features. The Don Juan or Casanova of our times who is erotic, exhibitionist||Sexually seductive, enticing, beguiling, tantalizing; glib and clever; disinclines real intimacy; indulges hedonistic desires; bewitches and inveigles others; pathological lying and swindling.|
|Compensatory narcissist||Including negativistic and avoidant features||Seeks to counteract or cancel out deep feelings of inferiority and lack of self-esteem; offsets deficits by creating illusions of being superior, exceptional, admirable, noteworthy; self-worth results from self-enhancement.|
|Elitist narcissist||Variant of “pure” pattern. Corresponds to Wilhelm Reich's "phallic narcissistic" personality type||Feels privileged and empowered by virtue of special childhood status and pseudo achievements; entitled façade bears little relation to reality; seeks favored and good life; is upwardly mobile; cultivates special status and advantages by association.|
|Fanatic narcissist||Including paranoid features||An individual whose self-esteem was severely arrested during childhood, who usually displays major paranoid tendencies, and who holds on to an illusion of omnipotence. These people are fighting delusions of insignificance and lost value, and trying to re-establish their self-esteem through grandiose fantasies and self-reinforcement. When unable to gain recognition or support from others, they take on the role of a heroic or worshipped person with a grandiose mission.|
Other theorists have identified two types of narcissism. Those narcissists who have been diagnosed with narcissistic grandiosity express behavior "through interpersonally exploitative acts, lack of empathy, intense envy, aggression, and exhibitionism."Another type of narcissism is narcissistic vulnerability. It entails (on a conscious level) "helplessness, emptiness, low self-esteem, and shame, which can be expressed in the behavior as being socially avoidant in situations where their self-presentation is not possible so they withdraw, or the approval they need/expect is not being met."
Clinical strategies are outlined by Heinz Kohut, Stephen M. Johnson and James F. Masterson, while Johns discusses a continuum of severity and the kinds of therapy most effective in different cases. Schema Therapy, a form of therapy developed by Jeffrey Young that integrates several therapeutic approaches (psychodynamic, cognitive, behavioral etc.), also offers an approach for the treatment of NPD. It is unusual for people to seek therapy for NPD. This is partly due to the NPD sufferers’ not believing they have a problem. Most, if not all, are unable to see the destructive damage they are causing to themselves and to others and usually only seek treatment at the insistence of relatives and friends. Unconscious fears of exposure or inadequacy often cause defensive disdain of therapeutic processes. Pattern change strategies, over a long period of time, are for narcissists to work on increasing their ability to become more empathetic in everyday relationships. To help modify their sense of entitlement and self-centeredness schema, the strategy is to help them identify how to utilize their unique talents and to help others for reasons other than their own personal gain. This is not so much to change their self-perception of their "entitlement" feeling but more to help them empathize with others. Another type of treatment would be temperament change.
Anger, rage, impulsivity and impatience can be worked on with skill training. Therapy is not one hundred percent effective because patients receive feedback poorly and defensively. Anxiety disorders and somatoma dysfunctions are prevalent but the most common would be depression. Medication has proven ineffective for treating narcissistic personality disorder, but psychoanalytic psychotherapy has a higher success rate. Therapists must recognize the patient’s traits and use caution in tearing down narcissistic defenses too quickly.
Group treatment has its benefits as the effectiveness of receiving peer feedback rather than the clinician’s may be more accepted, but group therapy can also contradict itself as the patient may show "demandingness, egocentrism, social isolation and withdrawal, and socially deviant behavior." Researchers originally thought group therapy among Narcissists would fail because it was believed that group therapy required empathy that NPD patients lack. However, studies show group therapy does hold value for patients because it lets them explore boundaries, develop trust, increase self-awareness, and accept feedback. Relationship therapy stresses the importance of learning and applying four basic interpersonal skills: "...effective expression, empathy, discussion and problem solving/conflict resolution."
Marital/relationship therapy is most beneficial when both partners participate.
In 2009, Twenge and Campbell conducted studies suggesting that the incidence of NPD had more than doubled in the US in the prior 10 years, and that 1 in 16 of the population have experienced NPD.
"A nationwide study in the United States found that 7.7 percent of men and 4.8 percent of women could be diagnosed with narcissistic personality disorder (Stinson et al., 2008). These data also suggest that narcissistic personality disorder is more prevalent among younger adults, possibly supporting the impression that narcissistic personality disorder is on the rise as a result of social and economic conditions that support more extreme versions of self-focused individualism (Bender, 2012)." 
The use of the term "narcissism" to describe excessive vanity and self-centeredness predates by many years the modern medical classification of narcissistic personality disorder. The condition was named after Narcissus, a mythological Greek youth who became infatuated with his own reflection in a lake. He did not realize at first that it was his own reflection, but when he did, he died out of grief for having fallen in love with someone that did not exist outside of himself.
Society and culture
In the film To Die For, Nicole Kidman's character wants to appear on television at all costs, even if this involves murdering her husband. A psychiatric assessment of her character noted that she "was seen as a prototypical narcissistic person by the raters: on average, she satisfied 8 of 9 criteria for narcissistic personality disorder... had she been evaluated for personality disorders, she would receive a diagnosis of narcissistic personality disorder."
- Malignant narcissism
- Narcissistic leadership
- Narcissistic mortification
- Narcissistic neurosis
- Narcissistic parent
- Narcissistic Personality Inventory
- Narcissistic rage and narcissistic injury
- Narcissism of small differences
- Narcissistic supply
- Narcissistic personality disorder – Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000)
- Groopman, Leonard C. M.D.; Cooper, Arnold M. M.D. (2006). "Narcissistic Personality Disorder". Personality Disorders – Narcissistic Personality Disorder. Armenian Medical Network. Retrieved 2007-02-14.
- Millon, Theodore (1996). Disorders of Personality: DSM-IV-TM and Beyond. New York: John Wiley and Sons. p. 393. ISBN 0-471-01186-X.
- R. Kayne, ed. L.S. Wynn (4 March 2013). "What is Megalomania?" (Internet Archive). Wise Geek. Conjecture. Retrieved 16 April 2014.
- "Glossary of Terms -Narcissistic personality disorder". Bpdresourcecenter.org. 2009-11-05. Retrieved 2013-12-10.
- Freeman, Arthur; Angela Breitmeyer; Melissa Flint (2000). "The Challenges in Diagnosing Narcissistic Personality Disorder: Difficult to Define, but "We Know It When We See It"". Clinical Forum.
- Narcissistic personality disorder: Symptoms – MayoClinic.com." Mayo Clinic. N.p., n.d. Web. 2 Dec. 2011. http://www.mayoclinic.com/health/narcissistic-personality-disorder/DS00652/DSECTION=symptoms
- Ronningstam E (2011). "Narcissistic personality disorder: a clinical perspective". J Psychiatr Pract 17 (2): 89–99. doi:10.1097/01.pra.0000396060.67150.40. PMID 21430487.
- Narcissistic personality disorder: Symptoms – MayoClinic.com." Mayo Clinic. N.p., n.d. Web. 2 Dec. 2011. <http://www.mayoclinic.com/health/narcissistic-personality-disorder/DS00652/DSECTION=symptoms
- Development and Validation of the Childhood Narcissism Scale, SANDER THOMAES,1,2 HEDY STEGGE,1 BRAD J. BUSHMAN,3,4 TJEERT OLTHOF,1 AND JAAP DENISSEN. Department of Psychology, VU University, The Netherlands Department of Psychology, Utrecht University, The Netherlands Department of Psychology, University of Michigan Department of Communication Sciences, VU University, The Netherlands
- Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM, Ruan WJ, Pulay AJ, Saha TD, Pickering RP, Grant BF. (July 2008). "Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions". J Clin Psychiatry 69 (7): 1033–45. doi:10.4088/JCP.v69n0701. PMC 2669224. PMID 18557663.
- Narcissism and Narcissistic Defences in the Eating Disorders Glenn Waller, BA, MClinPsychol, DPhil, Jennie Sines, BSc3, Caroline Meyer, BSc, PhD, Anna Skelton, BSc3, Emma Foster, BSc
- "Disorder personalities at work", Belinda Board and Katarina Fritzon, 2005, Psychology, Crime and Law, 11(1), pp.17–32.
- Cooper AM: Narcissism in normal development, in Character Pathology. Edited by Zales M. New York, Brunner/Mazel, 1984, pp. 39–56.
- Schulze L, Dziobek I, Vater A, Heekeren HR, Bajbouj M, Renneberg B, Heuser I, Roepke S (2013). "Gray matter abnormalities in patients with narcissistic personality disorder". J Psychiatr Res 47 (10): 1363–9. doi:10.1016/j.jpsychires.2013.05.017. PMID 23777939.
- "Narcissists’ Lack of Empathy Tied to Less Gray Matter". PsychCentral. Retrieved 2014-04-24.
- "Narcissists’ Lack of Empathy Tied to Less Gray Matter". PsychCentral. Retrieved 2014-04-24.
- Golomb, Elan PhD (1992). Trapped in the Mirror. New York: Morrow, pp. 19–20.
- Dr. Ken Magid (1987). High risk children without a conscience. Bantam. p. 67. ISBN 0-553-05290-X. Retrieved 17 November 2012.
- Stephen M. Johnson (1 May 1987). Humanizing the narcissistic style. W.W. Norton. p. 39. ISBN 978-0-393-70037-4. Retrieved 29 October 2013.
- full list in DSM-IV-TR, p. 717.
- Identifying and understanding the narcissistic personality Elsa F. Ronningstam. Oxfard University Press Inc.
- American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association, 1994, p. 659.
- Golomb, Elan PhD (1992). Trapped in the Mirror. New York: Morrow, p. 22.
- Kernberg OF (1970). "Factors in the psychoanalytic treatment of narcissistic personalities". J Am Psychoanal Assoc 18 (1): 51–85. doi:10.1177/000306517001800103. PMID 5451020.
- Siegel JP (2006). "Dyadic splitting in partner relational disorders". J Fam Psychol 20 (3): 418–22. doi:10.1037/0893-3126.96.36.1998. PMID 16937998.
- Wurmser L, Shame, the veiled companion of narcissism, in The Many Faces of Shame, edited by Nathanson DL. New York, Guilford, 1987, pp. 64–92.
- Gabbard GO (1989). "Two subtypes of narcissistic personality disorder". Bull Menninger Clin 53 (6): 527–32. PMID 2819295.
- Young, Klosko, Weishaar: Schema Therapy – A Practitioner's Guide, 2003, p. 375.
- Ronningstam E (2010). "Narcissistic personality disorder: a current review". Curr Psychiatry Rep 12 (1): 68–75. doi:10.1007/s11920-009-0084-z. PMID 20425313.
- DSM-5: Proposed Revisions: Personality and Personality Disorders. American Psychiatric Association. 2010-02-13.
- Holden C (2010). "Psychiatry. APA seeks to overhaul personality disorder diagnoses". Science 327 (5971): 1314. doi:10.1126/science.327.5971.1314. PMID 20223959.
- Shedler J, Beck A, Fonagy P, Gabbard GO, Gunderson J, Kernberg O, Michels R, Westen D (September 2010). "Personality Disorders in DSM-5". American Journal of Psychiatry 167 (9): 1026–1028. doi:10.1176/appi.ajp.2010.10050746. PMID 20826853. Retrieved 30 November 2010.
- Narcissistic personality disorder – International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)
- "Millon, Theodore, Personality Subtypes". Millon.net. Retrieved 2013-12-10.
- Pincus AL, Ansell EB, Pimentel CA, Cain NM, Wright AG, Levy KN (2009). "Initial construction and validation of the Pathological Narcissism Inventory". Psychol Assess 21 (3): 365–79. doi:10.1037/a0016530. PMID 19719348.
- Young, Klosko, Weishaar: Schema Therapy – A Practitioner's Guide, 2003, chapter 10, pp. 373–424.
- Golomb, Elan PhD (1992). Trapped in the Mirror. New York: Morrow, p. 23.
- Kohut, Heinz, (1971). The Analysis of the Self: A Systematic Approach to the Psychoanalytic Treatment of Narcissistic Personality Disorders ISBN 978-0-8236-0145-5
- Sperry, Lynn (1999) Narcissistic Personality Disorder, Cognitive Behavior Therapy of DSM-IV Personality Disorders: Highly Effective Interventions for the Most Common Personality Disorders. (131–138). Ann Arbor, MI: Edwards Brothers.
- Megalomaniacs abound in politics/medicine/finance Business Day 2011/01/07
- Twenge, Jean M. & Campbell, W. Keith The Narcissism Epidemic: Living in the Age of Entitlement (2009)
- "McGraw-Hill Connect". Connect.mcgraw-hill.com. Retrieved 2014-04-25.
- Kernberg O, Borderline Conditions and Pathological Narcissism, 1967
- Kohut H The Psychoanalytic Treatment of Narcissistic Personality Disorders: Outline of a Systematic Approach, 1968
- Hesse M, Schliewe S, Thomsen RR (2005). "Rating of personality disorder features in popular movie characters". BMC Psychiatry (London: BioMed Central) 5: 45. doi:10.1186/1471-244X-5-45. PMC 1325244. PMID 16336663.
- The Culture of Narcissism, C. Lasch, New York: Norton; Revised edition (May 1991). ISBN 978-0-393-30738-2
- How to Survive Working for a Narcissistic Leader (2011-05-19) BNet
- The Narcissism Epidemic, Jean M. Twenge, Ph.D. and W. Keith Campbell, Ph.D., New York, Free Press 2009 ISBN 978-1-4165-7625-9
- DSM-IV-TR Narcissistic Personality Disorder Diagnostic Criteria
- Narcissistic personality disorder PubMed
- Narcissistic personality disorder Mayo Clinic
- Narcissistic Personality Disorder Cleveland Clinic