Narcissists can feel emotional pain, but not usually in the same way as others. The emotional pain they may feel is usually related to underlying selfish needs.
Underneath the displays of superiority and sense of entitlement, they often feel empty, powerless, and shameful, which they perceive as weakness.
They are afraid of painful emotions and narcissists have a strong need to control these feelings.
They act as they do as a defense mechanism to prevent themselves from feeling emotional pain.
They may feel inferior, so they act superior, they feel undesirable, so they act confident.
Another way they avoid these painful emotions is denial, anger, and blame of others. Narcissists distort, rationalize, and delude themselves so they are blameless.
Narcissists may also act as if they feel emotional pain in order to manipulate others.
What Is Narcissistic Personality Disorder?
Narcissism (narcissistic personality disorder) is a psychiatric disorder characterized by a pattern of self-importance (grandiosity), an endless need for admiration and attention, and a lack of empathy for others.
What Are Symptoms of Narcissistic Personality Disorder?
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines narcissistic personality disorder as one that has:
- A pervasive pattern of grandiosity (in fantasy or behavior)
- A constant need for admiration
- A lack of empathy
The above personality traits begin by early adulthood and are manifested by at least five of the following nine criteria:
- An extreme sense of self-importance
- Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
- A belief that he or she is special and unique and can only be understood by, or should associate with, other special or high-status people or institutions
- A lack of empathy
- A need for excessive admiration
- A sense of entitlement
- Exploitive behavior of others
- Envy of others or a belief that others are envious of him or her
- Arrogance and haughty behaviors or attitudes
What Causes Narcissistic Personality Disorder?
The cause of narcissistic personality disorder is unknown but it may be the result of a combination of biological, environmental, social, and psychological factors.
An unhealthy early parent-child relationship may be a major factor in the development of the disorder.
There does not seem to be a genetic link to the disorder.
Is There a Test for Narcissists or Narcissistic Personality Disorder?
Narcissistic personality disorder is diagnosed with a psychological evaluation.
Other personality disorders with similar characteristics must first be ruled out before narcissistic personality disorder is diagnosed.
There are no specific lab tests used to diagnose narcissistic personality disorder, but a toxicology screen may be used to rule out use/abuse of drugs and alcohol as the cause of the behaviors.
Personality tests may also be used to help diagnose narcissistic personality disorder, including:
- International Personality Disorder Examination (IPDE)
- Millon Clinical Multiaxial Inventory III (MCMI-III)
- Personality Diagnostic Questionnaire–4 (PDQ-4)
What Is the Treatment for Narcissistic Personality Disorder?
Treatment for narcissistic personality disorder usually involves a combination of psychotherapy and medication.
There are no specific medications used to treat narcissistic personality disorder, but medications may be used relieve certain symptoms or to treat other co-existing mental illnesses.
Medications used to treat symptoms of other mental illnesses that may accompany narcissism include:
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