Introduction 

CBS news interviewed author Jeffrey Kluger, who wrote The Narcissist Next Door: Understanding the Monster in your Family, Your Office, Your Bed, - In Your World. It is a book exploring NPD (Narcissistic Personality Disorder). Narcissism is a personality trait we all have to one degree or another. However, when this trait is the predominant feature of one's personality, it becomes dysfunctional and maladaptive. It also tends to cause distress in the individuals around the NPD person, as well in the person with NPD. Kluger does not mince words as he refers to them as Monsters (CBS News. September 13, 2014).

Defining Narcissism

Narcissism is love of the self. It is a personality trait, and when present in a mature and balanced personality, it is a desirable and healthy trait. To love oneself is critical and fundamental to self-care, healthy self-image, and self-esteem (Pincus, and Lukowitsky, 2010). Self love propels one toward goals, success, and happiness. It leads to healthy relationships when we value ourselves. When we value ourselves enough to defend ourselves, it keeps us safe, emotionally and physically. Self love drives us to take good care of our bodies. Without self love, numerous psychological problems occur. We think we are not deserving of happiness. We are consumed with inadequacy. We don't strive to succeed, may not have goals, and tolerate mistreatment and abuse from others. We neglect and abuse our bodies with lack of exercise, poor diet, smoking, illicit drugs, and excessive alcohol use. We let our appearance go, because we don't care enough about ourselves to look our best. Without some narcissism, we would be very miserable individuals.

Defining NPD

What if narcissism was the predominating feature of our personality? If our self-love was so inflated, that it eclipsed others? The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition) is the definitive guide to psychiatric conditions. It defines NPD as follows:

• Problems with identity- over or under reliance on the opinion of others, extreme valuing or devaluing of the self.

• Problems with self-direction- setting goals based on whether or not approval from others will be obtained, and extremes of personal standards- either very high, or very low based on an entitled attitude.

• Lack of empathy (Ritter, et al, Dziobek, Preißler, Rüter, Vater, Fydrich, Lammers, et al, 2011)

• Lack of true intimacy- many lovers and acquaintances, but no loved ones or friends.

• Grandiose thinking and behavior.

• Attention seeking.

• The above features are enduring and pervasive- they are lifelong character traits.

• They do not occur in a developmental stage where narcissism is an expected feature- e.g.- adolescence.

• The behavior is inconsistent with cultural norms- this is complicated- see the discussion below.

• The above features are not due to substance abuse or a medical condition.

(American Psychiatric Association, 2013).

People with NPD may use and manipulate others, sexually, financially, or for general power andcontrol purposes. The Narcissistic personality bounces back and forth between extremes of self esteem and self worth. Their grandiose, proud, egotistical behavior serves to mask the low self worth they actually feel. They engage in a constant internal struggle to compensate for their feelings of worthlessness. They deal with a lack of control by externalizing control to others, and building themselves up to far more than they are. Shame is a prominent feature of NPD (Ritter, Vater, Rüsch, Schröder-Abé , Schütz, Fydrich, Lammers, et al 2013) which the narcissistic personality is desperately trying to compensate for with the compulsion to act out constant grandiose displays. They tend to feel misery inside, and often make those around them miserable in turn.

Current Social Norms and Narcissism

When the DSM-5 was under development, the committee compiling it gave serious consideration to eliminating NPD as a diagnostic category (Miller, Widiger, & Campbell, 2010). That would have been quite an affront to narcissists to no longer officially recognize them as unique enough to get their own diagnostic category. We have built a culture in which self-esteem is paramount. There is a strongly held belief that any criticism is a threat to self-esteem. There is a belief that any effort should not just be recognized, but rewarded. Self esteem is granted, and is fragile. When you actually accomplish and achieve something through hard work, you gain self-respect. Self-respect is earned, and is much more durable and valuable.

 Displays of Narcissism

 We have become a narcissistic society. In a display of aural exhibitionism, people bark their personal business into cell phones in public places just loud enough for people around them to hear about the deals they are brokering, the orders they are issuing; how powerful and connected they are. Anyone, regardless of lack of true expertise, can edit a wiki page, or write a blog, or make a podcast for the world to see. Perhaps one of the most ironic showcases for narcissism is American Idol and similar shows, which are basically open auditions for hopeful singers. Some of the auditions reflect a remarkable display of inability to self-evaluate. When a contestant who is unable to carry a tune, or even project their voice gets up in front of experts in the music industry, and thinks that people will actually pay to listen to them, it is the epitome of narcissism. The offense that some of them take when they are informed they have no talent is yet another expression of their narcissism.

If it is a Cultural Norm, is it Still a Disorder?

A defining feature of abnormality is that it is a behavior which violates current cultural norms. What if grandiose, inflated, entitled, self love is a cultural norm? Is it still a disorder? Other criteria for abnormality must be considered. Violation of cultural norms is one criteria for abnormality, but other points to consider include:

Is the behavior:

• Maladaptive

• Dysfunctional

• Pervasive

• Enduring

• Persistent

• Distressing to the individual

• Distressing to others

• Potentially harmful

Pathological Forms of Narcissism

Narcissism can be damaging even if it does not meet the diagnostic criteria for NPD. This is known as pathological narcissism. There are some objective truths to consider, based on common sense, that are time tested, which are being abandoned in the name of political correctness. I think they deserve to be reconsidered.

1) All cultural practices are not of equal value.

Our ways are not better than the way of others. There are cultures which blames women for being raped, tells them they have dishonored their family by being victimized, and shuns them or may even imprison or execute them. This is a cultural practice that should be honored and valued? Part of narcissism is false humility- devaluing of the self, and one's culture, in an effort to jockey for position of the most humble.

2) The world owes you nothing.

I deserve this. I It can be quite a blow to spend years in college, graduate from a prestigious program, and not find a job in your field. You may do all the right things and not get promoted or recognized. Welcome to the world . There are no promises of success.

3) The world is not going to change for you.

My feelings are so important no one must ever offend me. Other people are not obligated to adjust their words and actions to your sensitivity level.

4) Some people can do things better than you.

This was something you learned for the first time in Kindergarten when another five year old could color between the lines, or write the alphabet neater.

5) The ignorant and uninformed are not in a position to render an expert opinion.

Go to YouTube and look at the comments attached to some videos. Opinions are expressed by people who have no frame of reference or even basic knowledge of the topic. Opinions are expressed by people who cannot write complete sentences, or spell correctly, and their opinion is supposed to hold weight? Reading a wiki page does not confer expertise on a topic. Particularly when the wiki page may have been edited by someone with less expertise than you. Expertise takes time and hard work to develop, and will always be relative. Someone will always know more than you, or know things you don't, or be able to apply theory to action better than you. If you want the satisfaction, prestige, and other rewards that come from being an expert on a topic- start working. It will take decades, and will always be an ongoing process (Nichols, 2014).

6) There is actually such a thing as being ignorant and uniformed.

This is not an insult. It is a starting point. Every expert was a beginner at some point. For all of us , it is also an ending point. No one can learn everything. No one has expertise across every field. The human mind is limited, our senses, memory, and capacity to reason and understand is limited, as is our lifespans. There is only so much time to learn about an incredibly complex universe. No matter who you are, and what you know, you will always be ignorant and uniformed about most things. Accept this with humility.

The Harm Pathological Narcissism Causes

A narcissistic display is not just boring to witness or obnoxious. A pattern of acting out grandiose self love, or narcissism is harmful to self and others. This harm can include:

• A sense of entitlement. The belief that the the world owes you. It will make for a very rude awakening when you learn that not everything in life will be handed to you.

• Self absorption. There are other people in the world beside you. Others are inconvenienced by self absorbed behavior, or even endangered- e.g.- reckless driving, as though yours was the only car on the road.

• Lack of manners and consideration for others.

• Lack of empathy for others. The inability to be concerned for and aware of the feelings of others will prevent intimacy, bonding, and attachment to others (Ritter, et al, 2011)

• No one is going to tell me what to do- no regard for authority.

• Victimization of others, because others don't matter.

• The belief you must never be offended.

• Hypersensitivity. Easily taking offense, and complaining or suing.

• Frivolous lawsuits. The belief that you deserve to get paid if someone hurts your feelings, frightens you, or embarrasses you.

• No frame of reference for how skilled you are, and what needs to be improved.

• No opportunity for true personal growth and development. We grow and develop when we become aware of our weaknesses and strengthen them.

• You become Ineducable- Defensiveness to criticism and constructive feedback, and belief that there is nothing else to learn prevents learning.

Psychotherapy for NPD

NPD, like all personality disorders, is treatable with CBT (Cognitive Behavioral Therapy) (Matusiewicz, Hopwood, Banducci, & Lejuez, 2010). One challenge is recognizing the need for therapy. The narcissistic personality will tend to hold the view that others need to change and conform their behavior to suit them. It may be difficult to conclude that therapy is necessary to address self-defeating thinking and behavioral patterns which are interfering with goals achievement and happiness.

Conclusion

To love oneself is essential to being a mature, responsible, and well-adjusted adult. When taken to extremes, and not tempered with humility and consideration for others, it is harmful, just as to not love oneself is harmful.

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References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th Edition). Washington, DC.

CBS News. (September 13, 2014). CBS This Morning. Retrieved September 13, 2014, from https://www.youtube.com/watch?v=xVDs4P5MRco

Matusiewicz, A.K., Hopwood, C.J., Banducci, A.N., Lejuez, C.W., (2010). The Effectiveness of Cognitive Behavioral Therapy for Personality Disorders. Psychiatry Clinics of North America. 33(3): 657–685. doi: 10.1016/j.psc.2010.04.007 PMCID: PMC3138327 NIHMSID: NIHMS297280

Miller, J.D., Widiger, T.A., Campbell, W.K. (2010). Narcissistic Personality Disorder and the DSM–V. Journal of Abnormal Psychology 119, 4, 640–649 0021-843X/10/$12.00 DOI: 10.1037/a0019529

Nichols, T. (2014). The Death of Expertise. The Federalist. Retrieved September 13, 2014, from http://thefederalist.com/2014/01/17/the-death-of-expertise/

Pincus, A.L., and Lukowitsky, M.R. (2010). Pathological Narcissism and Narcissistic Personality Disorder.The Annual Review of Clinical Psychology 0.1146/annurev.clinpsy.121208.131215 6:8.1–8.26.

Ritter, K. Vater, A., Rüsch, N., Schröder-Abé , M., Schütz, A., Fydrich, t., Lammers, C., and Roepke, C. (2013). Shame in patients with narcissistic personality disorder. Psychiatry Research. Retrieved September 14, 2014, from http://dx. doi.org/10.1016/j.psychres.2013.11.019i

Ritter, K., Dziobek, I., Preißler, S., Rüter, A., Vater, A., Fydrich, T., Lammers, C., Heekeren, H.R., and Roepke, S. (2011). Lack of empathy in patients with narcissistic personality disorder. Psychiatry Research 187. 241–247.