Psychiatry and Behavioral Health Rotation

Psychiatry EOR: Narcissistic personality disorder (Lecture)

Patient will present as → a 45-year-old male lawyer is being worked up for low back pain. He demands that he sees the chief neurosurgeon and won't let any staff in the room. He says he knows "very important people" and that there will be "trouble" if he waits longer than 5 minutes in the waiting room.

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Key Points

Need for admiration, grandiose thoughts, concerned about what others think yet lack empathy

  • Sense of entitlement
  • Lacks empathy
  • Reacts to criticism with rage

DSM-5 Diagnostic Criteria

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  • Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
  • Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
  • Believes 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).
  • Requires excessive admiration.
  • Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
  • Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
  • Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
  • Is often envious of others or believes that others are envious of him or her.
  • Shows arrogant, haughty behaviors or attitudes.

Psychotherapy

  • Cognitive, behavioral, psychoanalysis

Pharmacologic

  • Avoid medications with an abuse potential
IM_NUR_Narcissistic_V1.3_ Narcissistic personality disorder can be described as a condition in which people have an excessive sense of self-importance, lack empathy for others, and possess an extreme preoccupation with themselves causing them to seek the admiration of others. Beginning by early adulthood and present in a variety of settings, people with this personality disorder may inflate their accomplishments, get easily angered when criticized, show little interest in others experiences, and require excessive admiration.

Narcissistic Personality Disorder Picmonic

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Question 1
A 45-year-old male agrees to take part in a psychiatric research study of financial executives. The patient is the head of commodities trading at an international investment firm. The aim of the study is to track the incidence of narcissistic personality disorder among participants. Which of the following is characteristic of narcissistic personality disorder?
A
Preoccupation with order
Hint:
Preoccupation with order is characteristic of obsessive compulsive personality disorder.
B
Voluntary social withdrawal
Hint:
Voluntary social withdrawal is characteristic of schizoid personality disorder.
C
Hypersensitivity to rejection
Hint:
Hypersensitivity to rejection is characteristic of avoidant personality disorder.
D
Lack of empathy and sense of entitlement
E
Excessive emotionality and excitability
Hint:
Excessive emotionality and excitability is characteristic of histrionic personality disorder.
Question 1 Explanation: 
Lack of empathy and sense of entitlement are characteristic of narcissistic personality disorder. Patients have an exaggerated sense of self-importance, exhibit grandiose behavior, require excessive admiration, and react to criticism with rage. Other common features include a willingness to exploit others and preoccupation with success.
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