The History Of Narcissistic Personality Disorder And What We Know Now
Narcissistic personality disorder (NPD) is named after a character in Greek mythology called Narcissus. As the story goes, Narcissus was so good-looking, he fell in love with his own reflection in a pool of water. This self-admiration was so severe that he couldn’t tear himself away and eventually died of thirst and starvation.
Today, the term “narcissist” may be used colloquially to refer to someone who is self-centered or overly concerned with their appearance. In psychology, it has a different meaning, but how psychologists use the term has changed over the years. Today, narcissistic personality disorder is usually characterized by an overinflated sense of self-importance, a lack of empathy, and a need for admiration from others. If you’ve been impacted by NPD, consider seeking professional support through therapy.
The history of narcissism in psychology
The first use of the term “narcissism” was in 1889 by psychiatrist Paul Nacke, who coined the term to describe someone who treated his own body as a sexual object. Another psychiatrist, Havelock Ellis, also used the word around the same time and was the first to use narcissism as a clinical term.
Sigmund Freud used the term “narcissism” throughout his career, using it to describe four different phenomena: narcissism as a sexual perversion, narcissism as a stage of normal human development, narcissism as the love of self, and narcissism as object relations (when someone loves another person because they remind them of themselves or a parental figure). Freud also distinguished between primary narcissism, the stage in development when someone is primarily concerned with themselves, and secondary narcissism, self-love that develops later in life.
In the mid-to-late 1900s, the definition of narcissism started to evolve. In 1967, Otto Kernberg described “narcissistic patients,” an acceptable term in the 1960s that is no longer used today, as having a great need to be admired and loved by others, having a low opinion of themselves and a need for praise from others, and having an exaggerated sense of entitlement with fantasies of being powerful and all-knowing.
In 1971, psychoanalyst Heinz Kohut proposed that adults with narcissism go back and forth between irrationally overestimating themselves and having periods of irrational inferiority, thus making them rely on others to regulate their self-esteem and sense of value.
Later, in 1975, Otto Kernberg went on to distinguish normal narcissism from pathological narcissism. He theorized that normal narcissism usually leads someone to have realistic goals, a balanced sense of self, and the capacity to have deep, meaningful relationships, while pathological narcissism usually involves a sense of entitlement, an impaired ability to love or care for others, and a need to constantly pursue perfection.
Kernberg believed that grandiose narcissism was a “construct of all the positive and idealized characteristics of themselves and also of others into an unrealistic self-image,” and theorized that the person projected their negative opinions of themselves as narcissistic defenses. Kernberg’s theories on narcissism appear to be similar to the ways in which the term is used today.
Narcissistic personality disorder in the DSM
Narcissistic personality disorder was not included in the first version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I), which was published in 1952. Instead, it was first added to the DSM-III in 1980. At that time, the characteristics making up NPD’s diagnostic criteria were as follows:
- Grandiose sense of self-importance or uniqueness
- Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
- A need for constant admiration and attention
- A sense of indifference, rage, shame, emptiness, or humiliation in response to perceived criticism or defeat
- At least two of the following in relationships with other people:
- Entitlement or an expectation of special favors
- Exploitativeness, or taking advantage of others to indulge one’s own desires, or disregarding the rights or integrity of others
- Alternating between periods of devaluation and idealization
- A lack of empathy or an inability to recognize how other people feel
The DSM-III also clarified that these characteristics were not limited to periods of illness and were part of the person’s short- and long-term functioning. To qualify for a diagnosis of NPD, these symptoms needed to have caused significant distress or impairment in occupational or social functioning.
The DSM-III was revised in 1987 and eliminated the relationship characteristic of periods of devaluation and idealization, rationalizing that this could be covered by other aspects of the disorder, and added the criterion of preoccupation with feelings of envy.
The diagnostic criteria for NPD changed again with the DSM-IV in 1994, refining the diagnostic criteria even more. In this version, a diagnosis of NPD required a pervasive pattern of grandiosity, a lack of empathy, and a need for admiration beginning by early adulthood. Individuals also needed to display five or more of the following symptoms:
- Grandiose sense of self-importance
- Preoccupation with fantasies of power, beauty, brilliance, unlimited success, or ideal love
- The belief that they are special and should only associate with and be understood by other people or institutions with high status
- Requiring or demanding excessive admiration
- Sense of entitlement with unreasonable expectations of favorable treatment
- Taking advantage of others for their own ends
- Lacking empathy
- Being envious of others or believing people are envious of them
- Demonstrating arrogant or haughty behaviors
These changes remained largely unchanged in the DSM-V revised version and demonstrate how the diagnosis has evolved since it was first used to describe sexual deviancy in 1889.
What we know about narcissistic personality disorder today
Today, researchers have refined the characteristics of this disorder into several subtypes, although NPD is the only official diagnosis in the DSM-V. The two most common subtypes are grandiose (overt) narcissism and covert narcissism, also referred to as fragile or vulnerable narcissism. People with either type of NPD generally meet the DSM criteria for a diagnosis, but they may behave very differently. A person with overt narcissism may need to be the center of attention, even if it’s to the detriment of others. They may have an inflated sense of entitlement and require special attention, demanding admiration from others. When they don’t get the admiration they desire, they may act out with rage or violence. Overt narcissists often seem charming and flattering when it is advantageous to them. However, some people may perceive them as being arrogant.
Someone with covert narcissism may be more challenging to identify. They may act in a passive-aggressive fashion and have great skill at gaining sympathy from others. People with this type of narcissism may demonstrate narcissistic vulnerability, have delusions of being a victim, and blame their problems on others.
In current times, we’re also aware of treatment methods that may be effective for individuals with narcissistic personality disorder. Multiple types of therapy, including schema therapy, eye movement desensitization and reprocessing therapy, dialectical behavior therapy, and cognitive behavioral therapy, may help someone with NPD improve their relationships and maintain self-esteem in a healthy way.
If you’re interested in working with a therapist, consider an online platform like BetterHelp. With BetterHelp, you can speak with a qualified mental health professional from anywhere with a reliable internet connection at a time that works for your schedule.
Research supports the notion that online therapy can be as effective as in-person therapy. One review of 14 studies found that online treatment usually led to a 50% improvement in symptoms of multiple mental health conditions, including generalized anxiety disorder and depression.
Takeaway
- Previous Article
- Next Article