Seeks power over others. Has fantasies of unlimited success. Fears rejection and abandonment.
Psychologists have drawn a new composite sketch of narcissistic personality disorder just as some of the most narcissistic among us are vying for our affection: politicians.
A new study suggests the official diagnostic criteria for narcissistic personality disorder are far too narrow, and that in addition to the traditional arrogant narcissist who holds an over-inflated view of himself lives the "fragile" narcissist whose grandiosity is actually a cover for underlying feelings of worthlessness and inadequacy.
Politics demands supreme self-confidence, says lead author Drew Westen, a clinical psychologist and professor of psychiatry and psychology at Emory University in Atlanta. But when does it become pathological?
Despite its severity, narcissism is one of the least studied personality disorders, Westen and his colleagues write in a study to be published in the American Journal of Psychiatry in November.
That's in large part because virtually all studies have relied on questionnaires and patients to report about their own personalities. That's problematic for narcissists, Westen says, because they lack self-awareness and tend to minimize their own "psychopathology."
"By definition, if you have a narcissistic personality disorder you don't have much insight into it, because, frankly, it's phenomenally off-putting to other people," Westen says. "If you knew that you were sounding grandiose you'd probably stop it, because you wouldn't want to look like a jerk."
According to the Diagnostic and Statistical Manual of Mental Disorders, psychiatry's official nomenclature of mental illnesses, narcissistic personality disorder is indicated by five or more of nine criteria, including "requires excessive admiration" and "shows arrogant, haughty behaviours or attitudes."
But Westen says that emphasizes only the more overtly behavioural aspects of the disorder. So his team set out to provide a far richer portrait.
Instead of nine characteristics, they identified 18 to 30. And further analysis revealed three subtypes of narcissistic personality disorder: "grandiose/malignant," "fragile" and the "high-functioning/exhibitionist."
For their study, a random national sample of 1,201 psychiatrists and psychologists were asked to provide a detailed psychological description of an adult patient they were currently treating with a "personality pathology." In other words, someone whose pattern of thoughts, feelings, motivation and behaviour was causing distress or dysfunction in their lives.
A total of 377 patients met various diagnostic criteria for narcissistic personality disorder; 71 per cent were male, and their average age was 44.
"Narcissism in some ways is an exaggerated version of what we expect culturally males to be - strong and powerful and self-confident," Westen says. "It's not surprising that we see pathological extremes of that more in males."
In women, narcissism tends to be expressed through a self-preoccupation, a dramatic "drawing attention to herself" whether through beauty, accomplishments or constantly talking about herself.
The researchers found that people with narcissistic personality disorder are more hostile, critical and power-oriented than the guidebook of mental disorders "would lead us to expect." In addition to blatant grandiosity, the typical narcissist experiences "underlying pain, vulnerability, inadequacy and rage," they say.
"In politics you see elevated narcissism, and in theatre and Hollywood and in journalism," says Westen, author of The Political Brain: The Role of Emotion in Deciding the Fate of the Nation. "The same people who want to have their face on television or want to be up in front of a crowd, those are situations that draw people who are narcissistic and want to see their name in lights."
"The flip side is that it doesn't mean they're necessarily highly pathological. It simply means narcissism is an aspect of their personality. And it is often one that allows them to persevere in the face of difficulties."
Narcissists often don't seek help until they're in their 40s, he says, "when it starts to become clear to them, whether it's after a divorce or they haven't been promoted in ways they thought they would be promoted, that life is not going the way it was supposed to go for them."
"You don't see a lot of 20 or 22-year-old narcissists coming in for therapy, because they're quite happy with themselves."
Westen says professional ethics prevent him from making a diagnosis from a distance. But he says U.S. President George W. Bush "exudes" narcissistic traits and "a kind of cockiness when he doesn't know things." He admits he's speaking as much as a partisan as he is a psychologist; Westen is a Democrat. But he says that while John McCain and Barack Obama "obviously have some pretty healthy self-respect to think they can do the job," neither one strikes him as a terribly narcissistic person.
Still, "to imagine it's worth going through the rigours of (an election), what it's going to do to your family, the dirt that's going to be dredged up. It's not to negate that people also have values and things they clearly believe in," he says, "but you've got to have a certain degree of narcissism to be willing to put up with all of that."
"If you think about it, somebody does get elected to be president of the United States or prime minister of Canada. What are the odds that you of all people in your country are going to be the person who is chosen? They're extremely small.
"There is a level of self-confidence that realistically is above the level that anybody should have, to think you're going to beat the odds to make it."
skirkey@canwest.com The three subtypes of narcissism:
Grandiose/malignant narcissists: "Exploit others with little regard for their welfare." They have an exaggerated sense of self-importance, feel privileged and entitled, have little empathy, put their own needs first and tend to be critical and controlling of others.
Fragile narcissists: Experience alternating feelings of grandiosity and inadequacy. They tend to be unhappy, critical of others, anxious, envious, competitive and have extreme reactions to perceived slights or criticism.
High-functioning/exhibitionistic narcissists: Are "grandiose, competitive, attention seeking and sexually seductive or provocative." They tend to be highly articulate, energetic and goal-oriented.
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