How to Identify a Narcissistic Personality Disorder

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Over the past year, I’ve read plenty of speculation about the possibility that President Trump has a Narcissistic Personality Disorder. Comparing the diagnostic criteria to the public face, tweets, and televised interviews with President Trump could easily lead one to this conclusion. While it is certainly possible that he is quite different in private and may not warrant the diagnosis.

Here are the diagnostic criteria for diagnosing Narcissistic Personality Disorder: The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits.

To diagnose a narcissistic personality disorder, the following criteria must be met:

Impairments in self-functioning (A or B)

A.    Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem.

B.    Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.

Impairments in interpersonal functioning (A or B):

A.    Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over or underestimate of own effect on others.

B.    Intimacy: Relationships are largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others’ experiences and the predominance of a need for personal gain or pathological personality traits in the following domain:

·      Antagonism, characterized by: Grandiosity: Feelings of entitlement, either overt or covert; self-centeredness; firmly holding to the belief that one is better than others; condescending toward others.

·      Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.

·      The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.

·      The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.

·      The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

It does rather sound like the public impression of him.

One of my ongoing frustrations with the diagnosis of personality disorders is that they tend to be described as permanent and unchangeable. As someone who has worked with thousands of patients over the years, I think about personality disorders differently. It is useful to think of each personality disorder or personality style as existing on a continuum from relatively functional and healthy to dysfunctional and problematic. Often high levels of stress and difficult environmental circumstances can push someone from a functional personality style to a personality disorder. For example, someone with a narcissistic personality disorder could adapt and modify to being a very self-confident, risk taker. Here are the 10 personality disorders with labels when the personality style is more moderated and functional:

The American Psychiatric Association
Source: The American Psychiatric Association

Whether someone displays a personality disorder or a functional personality style depends on a number of factors. Flexibility and adaptability along with coping capacity are large determinants. The important idea is that while someone is unlikely to make wholesale changes in their personality, they can move from a personality disorder to a more functional personality style. Someone with a Narcissistic Personality Disorder is likely not suddenly going to become the picture of empathy and compassion, however, they can improve their functioning and become more aware of their need to seek more input from others and work at accommodating other’s needs. A person with an Avoidant Personality Disorder can recognize the positive aspect of being sensitive to the needs and feelings of others and pair this with some improved resilience to make this style work for them in relationships. Someone with an Obsessive-Compulsive Personality Disorder can modify when, where, and how their style is expressed while using the conscientious aspects to maximize their own performance.

My conclusion is that a personality disorder is not a life sentence to one form of misery or another. All personality disorders have parallel personality styles that can be more functional. People with a personality disorder can learn to adapt and grow to make their personal style work better for them and improve happiness and functioning.

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