Love Thyself but not too much Narcissistic Personality Disorder

On Monday, I posted about the normal-ish side of narcissism. It's considered a continuous personality trait, which means some of us have less, some more, but we all fall somewhere along the continuum. Today, I'm going to talk about folks who fall on one of the extreme ends of that spectrum--those with narcissistic personality disorder.

If you read my quick-and-dirty guide to personality disorders, you'll remember that narcissistic personality disorder falls into Cluster B: those marked by a high degree of drama and emotionality. According to the DSM-IV, narcissistic personality disorder is a pervasive pattern of grandiosity and need for admiration as evidenced by at least five of the following symptoms:

1. grandiose sense of self-importance (for example, expects to be recognized as superior without achievements to match)
2. preoccupied with fantasies of unlimited success, power, beauty, or ideal love
3. believes he/she is unique and special, and should only associated with people of higher status
4. requires excessive admiration
5. takes advantage of others to achieve his/her own ends
6. lacks empathy: is unwilling to recognize the feelings and needs of others
7. is envious of others and believes others are envious of him/her
8. shows arrogant, haughty behaviors and attitudes

To be considered a disorder, these symptoms have to manifest across situations and settings, MUST cause clinically significant distress (in this case ... usually for others) in one or more important areas of functioning, and can't be better accounted for by another mental disorder (bipolar disorder, for example, as individuals in a manic state can sometimes be quite grandiose). Narcissistic personality disorder can, however, be diagnosed along with a primary psychiatric disorder such as depression or substance dependence.

Risk factors for this disorder include things like learning manipulative behaviors from parents, unpredictable or unreliable caregiving, lack of affection and praise as a child, and being neglected or abused. If you learn early on that vulnerability is unacceptable, you might grow a pretty thick emotional shell, thick enough to keep you from recognizing and empathizing with others. However--remember my post about multifinality? Lots of people experience these things and don't turn out to have this disorder.



There are plenty of individuals with narcissistic personality disorder depicted in movies/television. How about this guy?

Dr. Christian Troy of Nip/Tuck via fanpop.com

Christian Troy was a pretty classic case. As far as I can recall. I believe he might have exhibited every single symptom in the DSM-IV criteria, and there was no doubt his behaviors caused a clinically significant amount of distress, both for himself and for many others. He showed the classic pattern of strong first impression that deteriorates quickly once you get to know him a bit, and short-term relationships as the norm.

Can you think of other movie or book characters who have this disorder? What tips you off? And how about real life? Have you ever had someone like this in your life? Do you recognize any of these qualities in yourself?

This week for the Sisterhood of the Traveling Blog, Lydia answers the question "If you’re querying now, or have in the past, how do you develop patience to wait for responses?" Go see what she has to say!



Demystification Monday Delusional Much

Have you ever accused someone of being delusional? Or, since many of you are writers (and I believe this sometimes goes with the territory)—have you ever been accused of being delusional?

Yeah. I hear that a lot. Oh, wait. I meant I hear it on television. Or I’ve read it. People don’t actually say that to me.

Not to my face, at least.

So, do you know what being delusional actually means?

A delusion, according to the DSM-IV-TR, is a false belief that:

1. Is based on an incorrect interpretation of reality

2. Persists despite evidence to the contrary

3. Is not ordinarily accepted by other members of the person’s culture or subculture (for you atheists out there, this is why people of faith are not considered delusional on that basis alone)

You can’t talk a truly delusional person out of his/her delusion. Probably best not to try. In fact, I’m telling you: Don’t do it.

Delusions are either:

Nonbizarre—these are beliefs based on things that could *technically* happen, like a belief your significant other is cheating on you, your best friend is secretly a government agent, you've been infected with a flesh-eating disease, etc.

OR

Bizarre—these are beliefs that stray far from the realm of plausibility within one’s culture, like thinking aliens break into your room every night and remove your memories one-by-one by inserting a pipe cleaner into your left nostril.

[Oh, there’s another way to distinguish delusions—mood-congruent vs. mood-incongruent, but I’ll get into that when I discuss MANIA! WHOOPEE!]

Ahem, moving on.

Delusions can involve just about anything under the sun, but I summarize a few of the more common themes below.

Persecutory—someone is doing something really, really bad to you. You know, like poisoning you, drugging you, harassing you, stalking you, spying on you, conspiring against you, or some combination of those. Imagine how frightening that must be.

Erotomanic—not nearly as fun as it sounds. You believe someone “of higher status” is in love with you, wants to marry you, etc.. When you hear on the news about some woman breaking into Leonardo DiCaprio’s home because she thinks they’re married … yep, probably an erotomanic delusion.

Grandiose—you have a special, unrecognized talent or ultra-exclusive knowledge! Jonathan Franzen has you on speed dial and calls you to brainstorm ideas for his novels! You know the secret to the universe! The special sauce!  Your invention can fix the economy, copy-edit a manuscript, AND grill you a sandwich! I read a thread on AbsoluteWrite recently that brought this kind of delusion to mind. For fear of being sued, I won’t paste the link, but it was sorta sad. And kind of jaw-dropping.

Somatic—oh, this is a rough one. You believe something really bad is going on with your body, like you’re infested with parasites, giving off a terrible odor, or have a body part that is not functioning or strangely misshapen.

There are some shades of grey, of course. Not everyone with weird beliefs is delusional! For example, there's something called "overvalued ideas": a belief that's strong, kinda strange and illogical to the average observer, and persists in spite of some evidence to the contrary. However, these can be differentiated from delusions by a professional--delusions are even more implausible, start more abruptly (as opposed to developing gradually over time), and the person who has the delusion won't care as much about what people think.*

If you’re writing a character who is delusional, you might want to check out a more in-depth article here. It will even tell you characteristics of folks who present with certain types of delusions, other conditions associated with delusions (schizophrenia, medical illnesses, etc.)… in other words, it’s a lot of good, reliable info.

From the realm of fiction, Wally Lamb did an amazing job of portraying a character experiencing all sorts of delusions in I Know This Much Is True. He captures Thomas’s genuine fear as a result of the delusions, as well as his brother Dominick’s intense frustration with his twin’s unshakeable beliefs in some truly bizarre things. 

Now, are you wondering if YOU are delusional?  Don’t worry. If you’re actually asking that question, you’re probably not deluded (uh, but do keep in mind that this blog is no substitute for assessment and treatment by a licensed mental health professional).

*Mullen & Linscott, 2010, Journal of Nervous and Mental Disease