Narcissism is a classed as a cluster B personality disorder. It resides with three other personality disorders, Histrionic, Anti-social (Dissocial) and Borderline or emotionally stable/unstable. Cluster B in medical terminology is to classify a set of traits that identify as personality disorders which demonstrate; manipulation, emotional outbursts, and delusions. It’s very difficult to diagnose, as the person with the disorder is unable to acknowledge they have a problem.
Personality disorders are long term patterns of thoughts and behaviours that cause serious problems in relationships and work.
Personality disorders are common mental health problems
In England, official figures estimate that around 1 in 20 people have a personality disorder. However, many people have only mild conditions so only need help at times of stress (such as bereavement) and may not have contact with mental health services. Other people with more severe problems may need specialist help for longer periods.
Mild personality disorders that don’t seriously interfere with a person’s ability to function socially are common. Severe disorders are rare and affect less than 2% of the population. When this figure is adapted to demonstrate a percentage of a population, the results look far more disturbing. However, many of the cluster B personality disorders are reluctant and unlikely to seek help.
England has an average population 64,000.000. Therefore, 2 % of this population 1,280,000 has a severe personality disorder.
People who have a mild to moderate PD seek treatment. People with more severe personality disorders, especially borderline and antisocial PD, may be more likely to come into contact with medical or forensic services due to the consequences of their behaviour, even though they are reluctant to seek treatment. Either because they don’t believe anything is wrong with them, or because they are afraid of contact with health professionals. This could be regarded as afear of being exposed!
Personality disorder are categorised into three clusters – A, B or C
Cluster A personality disorders (Odd eccentric)
A person with a cluster A personality disorder tends to have difficulty relating to others and usually shows patterns of behaviour most people would regard as odd and eccentric. Others may describe them as living in a fantasy world of their own.
Paranoid personality disorder
A person with a paranoid personality disorder is extremely distrustful and suspicious.
•thinking other people are lying to them or trying to manipulate them
•feeling they cannot really trust their friends and associates
•worrying that any confidential information shared with others will be used against them
•thinking there are hidden meanings in remarks most would regard as innocent
•worrying that their spouse or partner is unfaithful, despite a lack of evidence
Schizoid personality disorder
Someone with a schizoid personality disorder may appear cold and detached, and avoid making close social contact with others.
•preferring to take part in activities that do not require interaction with others.
•having little desire to form close relationships, including sexual relationships.
•being uninterested when receiving criticism or praise.
•having a limited ability to experience pleasure or joy.
Schizotypal personality disorder
A person with a schizotypal personality disorder is likely to have poor social skills and delusional thoughts, behave in unusual ways.
•attaching undue and misguided significance to everyday events – such as thinking newspaper headlines are secret messages to them.
•believing in special powers – such as telepathy or the ability to influence other people’s emotions and actions.
•having unusual ways of speaking – such as long, rambling vague sentences or going off on a tangent.
•experiencing excessive anxiety in social situations – even if they have known a particular person or group of people a long time.
Cluster B personality disorders (Dramatic/Erratic)
A person with a cluster B personality disorder struggles to regulate their feelings and often swings between positive and negative views of others. This can lead to patterns of behaviour others describe as dramatic, unpredictable and disturbing.
Borderline personality disorder, also Emotionally stable/unstable
Borderline personality disorder (BPD) can cause a wide range of symptoms, which can be broadly grouped into four main areas. A person BPD is emotionally unstable, has impulses to self-harm, and has very intense and unstable relationships with others. They may be stuck with a very rigid “black-white” view of relationships.
The four areas are:
Emotional instability (a psychological term for this is affective dysregulation) may experience a range of often intense negative emotions, such as: rage, sorrow, shame, panic, terror, long-term feelings of emptiness and loneliness.
Disturbed patterns of thinking or perception (psychological terms for these are cognitive or perceptual distortions) upsetting thoughts – such as thinking you are a terrible person or feeling you do not exist.
strange experiences – such as hearing voices outside your head for minutes at a time. These may often feel like instructions to harm yourself or others. You may or may not be certain whether these are real.
prolonged episodes of abnormal experiences – where you might experience both hallucinations (voices outside your head) or distressing beliefs that no one can talk you out of (such as believing your family are secretly trying to kill you).
These types of beliefs may be psychotic (delusions), and a sign you are becoming more unwell.
Impulsive Behaviour, an impulse to self-harm – such as cutting your arms with razors or burning your skin with cigarettes; in severe cases, especially if you also feel intensely sad and depressed, this impulse can lead to feeling suicidal and you may attempt suicide.
a strong impulse to engage in reckless and irresponsible activities – such as binge drinking, drug abuse, going on a spending or gambling spree, or having unprotected sex with strangers; impulsive behaviours are especially dangerous when people are in brief psychotic states, because they may be more likely to act impulsively if their judgement is impaired
Intense but unstable relationships with others, you may feel that other people abandon you when you most need them or get too close and smother you.
When people fear abandonment, it can lead to feelings of intense anxiety and anger. They may make frantic efforts to prevent being left alone, such as:
•constantly texting or phoning a person
•suddenly calling that person in the middle of the night
•physically clinging on to that person and refusing to let go
•making threats to harm or kill themselves if that person ever leaves them
Alternatively, you may feel others are smothering, controlling or crowding you, which also provokes intense fear and anger.
These two patterns will probably result in an unstable “love-hate” relationship with certain people.
A relationship is perfect and that person is wonderful, or the relationship is doomed and that person is terrible. People with BPD seem unable or unwilling to accept any sort of grey area, in their personal life and relationships. BPD is now more widely known as emotionally stable/unstable PD.
Histrionic personality disorder
A person with histrionic personality disorder is anxious about being ignored. As a result, they feel a compulsion (overwhelming urge) to be noticed and the centre of everyone’s attention. Features include:
•displaying excessive emotion, yet appearing to lack real emotional sincerity
•dressing provocatively and engaging in inappropriate flirting or sexually seductive behaviour
•moving quickly from one emotional state to another
•being self-centred and caring little about other people
•constantly seeking reassurance and approval from other people
Symptoms and signs may co-exist with borderline and narcissistic personality disorders.
Narcissistic personality disorder
A person with narcissistic personality disorder swings between seeing themselves as special (grandiosity) and fearing they are worthless (insecurity). They act as if they have an inflated sense of their own importance and show an intense need for other people to look up to them. To be admired and revered.
Typically narcissists will; •exaggerate their own achievements and abilities
•thinking they are entitled to be treated better than other people
•exploiting other people for their own personal gain
•lacking empathy for other people’s weaknesses
•looking down on people they feel are “beneath” them, while feeling deeply envious of people they see as being “above” them.
Antisocial personality disorder
A person with an antisocial personality disorder sees other people as vulnerable and may intimidate or bully others without remorse. They lack concern about the consequences of their actions.
•lack of concern, regret or remorse about other people’s distress
•irresponsibility and disregard for normal social behaviour
•difficulty in sustaining long-term relationships
•little ability to tolerate frustration and to control their anger
•lack of guilt, or not learning from their mistakes
•blaming others for problems in their lives
Cluster C personality disorders (Anxiety/fearful)
Cluster C personality disorder fears personal relationships and shows patterns of anxious and fearful behaviour around other people. Others may be withdrawn and reluctant to socialise, struggles with persistent and overwhelming feelings of fear and anxiety. They may show patterns of behaviour most people would regard as antisocial and withdrawn.
Avoidant personality disorder
A person with avoidant personality disorder appears painfully shy, is socially inhibited, feels inadequate and is extremely sensitive to rejection. The person may want to be close to others, but lacks confidence to form a close relationship. Unlike people with schizoid personality disorders, they desire close relationships with others, but lack the confidence and ability to form them.
Dependent personality disorder
A person with dependent personality disorder feels they have no ability to be independent. They may show an excessive need for others to look after them and are “clingy”. Other features include:
•finding it difficult to make decisions without other people’s guidance
•needing others to take responsibility over what should be their own important life choices
•not being able to express disagreement with other people
•finding it difficult to start new activities due to a lack of confidence
•going to extremes to obtain support and comfort
•feeling helpless and uncomfortable when alone
•urgently needing to start a new relationship once a previous relationship comes to an end
•having an unrealistic and constant fear they will be left alone to fend for themselves
Obsessive compulsive personality disorder
A person with obsessive compulsive personality disorder is anxious about issues that seem out of control or messy. They are preoccupied with orderliness and ways to control their environment, and may come across to others as a “control freak”.
•having an excessive interest in lists, timetables and rules.
•perfectionism, being so concerned with completing a task perfectly that they have problems completing it.
•being a workaholic.
•having very rigid views about issues such as morality, ethics and how a person should behave in daily life.
•hoarding items that seem to have no monetary or sentimental value
•being unable to delegate tasks to other people
•disliking spending money, as they think it is always better to save for a “rainy day”
This personality disorder differs from obsessive compulsive disorder (OCD), a related mental health condition, in several important ways:
People with OCD are aware that their behaviour is abnormal and are anxious about it. People with obsessive compulsive personality disorder think their behaviour is perfectly acceptable and have no desire to change it.
Some people with OCD are compelled to carry out rituals, checking you’ve locked the back door, or touching every second red car. This is not usually the case with people with obsessive compulsive personality disorder.
People with OCD may feel compelled to make lists or organise items in their house, but feel anxious about doing so. People with obsessive compulsive personality disorder find relief from anxiety when doing such tasks and may become irritated when prevented from doing so.
There are two manuals that specify clinical guidelines of the main Personality disorders;
DSM IV-TR. The APA’s Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM IV-TR). ICD-10 The WHO’s International Statistical Classification of Diseases and Related Health Problems, tenth edition
DSM defines ASPD as;
A) A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three or more of the following:
failure to conform to social norms with respect to lawful behaviours as indicated by repeatedly performing acts that are grounds for arrest;
Deception, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure;
Impulsivity or failure to plan ahead;
Irritability and aggressiveness, as indicated by repeated physical fights or assaults;
Reckless disregard for safety of self or others;
Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behaviour or honour financial obligations;
Lack of remorse, as indicated by being indifferent to or rationalising having hurt, mistreated, or stolen from another.
B) The individual is at least age 18 years.
C) There is evidence of conduct disorder with onset before age 15 years.
D) The occurrence of antisocial behaviour is not exclusively during the course of schizophrenia or a manic episode.
ICD-10 defines ASPD as; Dissocial Personality Disorder, It is characterised by at least 3 of the following:
Callous unconcern for the feelings of others;
Gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations;
Incapacity to maintain enduring relationships, though having no difficulty in establishing them;
Very low tolerance to frustration and a low threshold for discharge of aggression, including violence;
Incapacity to experience guilt or to profit from experience, particularly punishment;
Marked readiness to blame others or to offer plausible rationalisations for the behaviour that has brought the person into conflict with society.
The ICD states that this diagnosis includes ‘amoral, antisocial, asocial, psychopathic, and sociopathic personality’. Although the disorder is not identical with conduct disorder, presence of conduct disorder during childhood or adolescence may further support the diagnosis of dissocial personality disorder. There may also be persistent irritability as an associated feature.
Psychopathic traits are assessed using various measurement tools, including Canadian researcher Robert D. Hare’s Psychopathy Checklist, Revised (PCL-R).
However; Psychopathy is not the official title of any diagnosis in the DSM or ICD.