Laziness

Laziness:  the suffering remains the same.

The concept of laziness carries with it a whole mess of baggage.  It is hard to imagine being lazy in any other way but physical, as in ‘bone-idle’.  But, in this article, I wish to take on the task of explaining the concept of spiritual laziness.  First of all, it would be nice to address the possibility that humans have a need for spirituality.  It has been long been held that we humans have an innate ability to experience spiritual sensations.  There has been research recently postulating the possibility of a religious center of the brain.  A part of the brain lights up when we encounter a religious thought, etc.  I do not wish to go there.  I guess that’s for another article.

The concept of spiritual laziness can be described as an inability to provoke the system to change undesirable feelings and expressions.  In other words, change.

Change is the only thing that can actually take us from suffering to non-suffering.  Notice that there is no good synonym for non-suffering.  If we wish to end our suffering we must change from our present day strategies for something called the opposite of that.  If we are imbedded in a life stream that is not working for us, then we must change course and, logically, it should be the opposite way.  But not in a way that distorts the context of a life-time continuum.  If we decide to leave a job to ease our suffering, the void that the job leaves in our psyche will be filled by a greater suffering scale from other aspects of our lives.  In other words, cutting off things in our life does not ease the amount of suffering.  It simply decreases the amount of stuff that leads to our suffering.  The suffering remains the same.

For example, if we are in a state of anxiety and we have no real idea why we are suffering, then we should have no idea which direction we should take.  But, given that we have a very detailed daily routine – thought-wise as well as environmental, we can make decision on those elements.  If we are in a relationship, should we change that relationship.  If we are in a job that we do not like, should we change jobs.  I guess by now you can imagine that we rarely make those kind of decisions.  We hold on to all our life stuff and hope that we can change the suffering by working out, building hobby trains or watching a movie.  Subterfuge, distraction, a break, call it what you will, it is definitely not change.  Hobbies, technically, cannot lead to non-suffering.  They make suffering more tolerable.  We balance suffering with activities that give us some kind of a break from suffering.  Logically, that does not make the suffering change to non-suffering.

I guess it is difficult to imagine the change needed to end suffering.  It is easier to go with the concept that suffering is there and will always be there, so why fight it.  Let’s get all kinds of buffers to shield us from suffering.  This requires an enormous effort.  Being a consumer is a full-time job.  There are many ways to be a consumer.  Buying stuff is not the only way to be a consumer.  We also fill our heads with all kind of nonsense.  Materialism has many facets, many don’t require the process of monetary exchange.

Effortlessness:

A good movie is about 90 minutes, a catchy song about 2 1/2 minutes.  Why these magic times?  It would seem that these are times that make the experience effortless.  As opposed to writing, which is a slow process that requires a certain manic energy to accomplish.  You have to write and write and write.  Then re-write and re-write.  You can use a piece of paper and pen or a typewriter or a computer.  Either way, there is a learning paradigm attached to any medium you choose.  You have to be able to write with a pen, or type on a keyboard.  Enter YouTube.  Who would of thunk that there was a medium that would change the way we communicate.  Talk into a camera and post it online.  A few million hits later, you have a career.  Now that’s effortless.  But, I digress.  Something that is effortless should be enjoyable.  I am aware of many people that can play any riff on a guitar but I have never heard any one of them play a song.  Or know a few hundred chords and never write a song.  Does doing something have to be accompanied with suffering?  I am not too sure.

People who have to write a song, probably do so because they are good at it.  Perhaps, the only thing stopping them is laziness.  I don’t know if I could write a song.  With George Martin by my side, I may actually put something (pardon the pun) together.  By myself, forget about it.

Back to effortlessness.  Does 10,000 hours of slogging it out make something effortless.  Thanks, Malcolm.  Well, Gladwell seems to think so.  The effort it takes to clock that many hours into something has to have a reward: expertise.  Since when is expertise a desired outcome in life.  Ask anyone what they want out of life and they may respond:

I want a sweet ass job I love. Someone nice to come home to maybe? Happiness and love and shiz. A book deal. Peace. No drama. No panic. I want to be healthy. I want to travel the world [at least a little bit]. I want to be able to totally relax. I want to be able to do what I want. I want the people around me to be happy. I want no pain, physical or otherwise. I want..

I actually don’t think there are 100 things I want in life, I think there are just these ones. They’re sort of big and important, and if I had these then I’d be super happy.

Oh, I would also really like a pug and a lot of money.

(response at an internet blog asking what are the 100 things you want in life)

Googling ‘what people want in life’ I was not surprised to find out that our world can be split into materialism and non-materialism ‘needs’.  I chose to focus on the intrinsic needs part and here is a list of ‘wants’ that some people want in life.  This list is from a Zen-type center.

• • • to have some clarity of mind;
    • to feel each day more nearer to my inner self, be centered;
    • to know myself;
    • to have a greater level of spiritual joy that raises me above our human burdens;
    • to live with intention and purpose;
    • to be in the ocean of love and wisdom;
    • to get a meaningful glimpse of the spiritual good side of everyone I come in contact with;
    • to learn how to meditate when you do not have a lot of time to do so;
    • to know how to abandon the shallower world around us to reach greater levels of peace;
    • to really feel alive. I know that feeling. It doesn’t matter if you feel sad or happy there is a richness to it that is sometimes missing and I feel a dullness;
    • to feel connected and not separated and lost would change my life;
    • to stop searching answers to unanswerable questions and just live;
    • at the end, to be able to say I made a positive change that had a major effect on a large community (leaving the world better off somehow)
    • the one thing I want out of life is purpose. To find my calling and live it
    • to know that I am on the path to finding and following my calling;
    • to help people heal old wounds;
    • to live with intention and purpose;
    • to live my life as I do and want, to grow my soul through the lessons;
    • to be creative;
    • to learn how to stop myself from being short with my loved ones when they try to be kind;
    • to understand life’s purpose;
    • it would drastically change my life having a clear objective and a clear way of pursuing it;
    • to be who I am, total connection with my spirit;
    • to end disconnection from others (which leads to loneliness);
    • to be in touch with life;
    • to be intimate and less afraid;
    • to have peace of mind;
    • to be free from worry and fear
    • to honor our bodies, our minds, our spirits – and each other;
    • to feel serenity in making life decisions that are aligned with all those values;
    • to be peaceful so I may be free of these knee jerk responses so that I may act from compassion and wisdom;
    • to have peace of mind and clarity;
    • to stop my perfectionism and actually do better at work and in everything else;
    • to have silence in my head;
    • to turn off that inner voice always talking;
    • to get rid of unwanted negative thoughts;
    • to stop judging my thoughts;
    • to ride peacefully with whatever is presented on my journey;
    • to learn how to maintain internal emotional peace (especially from fear), so that I can gain self-confidence.
    • to learn step by step processes on how let go, detach, not judge, feel inner peace;
    • how to control anguish, frustration, and not to let others harm you;
    • not to compare my needs with others and be attached to outcomes to look good;
    • how to feel free. I know it is all in my head, but I often feel hindered by other people and their demands. Why can I not be who I am and not feel guilty about it?
    • to master time-management;
    • to develop self discipline;
    • to create good habits;
    • to experience a paradigm shift that helps me view challenges differently, especially relating to self discipline and motivation;
    • to learn how to be in the zone;
    • to be more productive and focused;
    • to build enough self-confidence to spread my message to wider audiences;
    • to quiet the negative self-talk;
    • to move away from negative self-limiting thoughts;
    • to quell my self doubts and just get on with it so that my life doesn’t feel like it’s one step forward and two steps back;
    • to recognize all the good in my life, and being content with it.
    • to worry less about my performance at work (which is very high, but due to family conditioning, I always feel ‘on trial’);
    • to feel more courage, and less embarrassment;
    • to be confident about consistently making good decisions;
    • to fInd a way to earn a living doing something that contributes to others, yet doesn’t rob my soul;
    • to find a passion and stick with it;
    • to find a way to pursue my calling while also supporting my family financially.
    • to be able to find fulfilment in my career.
    • to find how to reconcile productivity and relaxation. Oftentimes I get so engaged in my work that I end up burning out or running into hours for relaxation.
    • to truly zero in on the essence of what my talent or gift is;
    • to realize that what I have to offer is exactly what the world needs at this point in time;
    • to achieve my fullest potential in terms of skills that I have;
    • to translate my potential into a comfortable lifestyle for me and my family;
    • to feel like I’m not just ‘going through the motions’ at work and remove the feeling that my ‘real’ life is lived outside of work
    • to know what I want and have the resolve not to re-evaluate it too soon;
    • to feel more free, and that my many, many obligations would not be an obstacle to feel free.
    • to know that what I’m doing is worthwhile – raising kids, the work I do, the way I live my life and interact with people.
    • to make a positive difference for people close to me. and therefore be happy.
    • to maintain a good work/life balance;

And from the blog Zenhabits, here is some advice that, supposedly, can bring some form of happiness.

It starts by:

Life can be ridiculously complicated, if you let it. I suggest we simplify.

Thich Nhat Hanh’s quote, which I’ve stolen as this site’s subtitle, is the shortest guide to life you’ll ever need: “Smile, breath, and go slowly.”

If you live your life by those five words, you’ll do pretty well. For those who need a little more guidance, I’ve distilled the lessons I’ve learned (so far) into a few guidelines, or reminders, really.

And as always, these rules are meant to be broken. Life wouldn’t be any fun if they weren’t.

the brief guide:

less TV, more reading
less shopping, more outdoors
less clutter, more space
less rush, more slowness
less consuming, more creating
less junk, more real food
less busywork, more impact
less driving, more walking
less noise, more solitude
less focus on the future, more on the present
less work, more play
less worry, more smiles
breathe

To summarize, we want to be happy.  But happy in a very specific way.  Less worries, less hassles, less of everything but more free time to avoid all the things we don’t want.  Ironic.

The Hindu : Arts / Magazine : Ride; don’t hide

Today is World Mental Health Day; a day to salute people like Michael Schratter who are battling the stigma associated with mental illness.

What sets Mental Health issues apart from other health issues? Almost all of us know the answer. It is stigma. A person suffering from a mental illness not only has to contend with a difficult ailment but is also weighed down by the additional burden of the stigma associated with the condition.

Ignorance

Stigma is a product of ignorance. The only way to deal with it is through education: what causes mental illness, why bizarre symptoms occur and why mentally ill people are no different from the rest of the population.

Canada is one country which does a wonderful job of making the general public more aware and makes treatment options available to the mentally ill. This allows the mentally ill to be productive members of society. Michael Schratter is one such person. He is attempting to cycle around the world in an effort to battle the stigma of mental illness one pedal at a time!

Michael, a std. V teacher, has embarked on a journey from Vancouver in British Columbia on Canada’s West Coast and proposes to bike the equatorial distance of 40,000 km. While doing so, Michael will write for the Vancouver Newspaper periodically. Michael suffers from Bipolar Disorder but does not let this illness define who he is.

Michael’s column explores the issues surrounding mental illness and will try to dissolve the stigma that surrounds this common human condition. Michael believes that he can convince the world that mentally ill people are just people, different types of people with different goals and aspirations all trying to live a fulfilling life.

“I can’t think of another affliction that harbours as much stigma as mental illness. How is it that, in the third millennium, this illness still carries so much negativity, fear, and misunderstanding?” he asks.

Conclusions

As a teacher Michael tried to answer this question. Here are some of his conclusions:

When mentally ill employees fall sick they need time off due to medical reasons that are not directly visible. This causes suspicion of, among other things, malingering and feigning illness.

Unpredictability is viewed as dangerous and the “Jekyll and Hyde” nature of some forms of mental illness is considered threatening by the general public.

Science has proven, and repeatedly asserts, that mental illness is caused by chemical imbalances in the brain. Yet most people view the troubling behaviours caused by mental illness as signs of an impure soul or flawed personality. In India, the patient is seen as possessed by evil spirits and subjected to inhumane treatment.

Media, especially the visual media, portrays mentally ill people as “dangerous.” This is far from the truth since they are more likely to hurt themselves than others. However, as long as the myth is propagated, the stigma persists.

Often mentally ill people are homeless and are used by drug pushers. Thus they become addicts too. Their behaviour thus is a product of both their condition, but ignorance attributes it to mental illness alone and they are shunned further causing a vicious cycle.

Whatever the cause, stigma is tenacious and it can be a killer. We need to help victims battle this stigma and, like Michael, have the courage to RIDE NOT HIDE!

Antisocial personality disorder

Antisocial personality disorder is a condition in which people show a pervasive disregard for the law and the rights of others. People with antisocial personality disorder may tend to lie or steal and often fail to fulfill job or parenting responsibilities. The terms “sociopath” and “psychopath” are sometimes used to describe a person with antisocial personality disorder.

Early adolescence is a critical time for the development of antisocial personality disorder. People who grow up in an abusive or neglectful environment are at higher risk, and adults who suffer from the disorder were usually showing behavioral problems before the age of 15. Antisocial personality disorder affects men three times as often as it does women and is much more prevalent in the prison population than in the general population.

Antisocial personality disorder is a chronic condition and represents one of the most difficult personality disorders to treat. However, psychotherapy and some medications may help alleviate symptoms. In many cases, the symptoms of antisocial personality disorder decrease as the person reaches middle age.

What are the signs and symptoms of Antisocial Personality Disorder?

The classic person with an antisocial personality is indifferent to the needs of others and may manipulate through deceit or intimidation. He or she shows a blatant disregard for what is right and wrong, may have trouble holding down a job, and often fails to pay debts or fulfill parenting or work responsibilities. They are usually loners.

People with antisocial personality disorder can be aggressive and violent and are likely to have frequent encounters with the law. However, some antisocial personalities may also possess a considerable amount of charm and wit.

DSM IV Criteria for Antisocial Personality Disorder

Defined as: A pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years old, as indicated by 3 or more of the following:

• failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
• deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
• 2pt”>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 behavior or honor financial obligations
• lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

The individual must be at least 18 years old.

There is evidence of Conduct Disorder with onset before age 15.

The occurrence of antisocial behavior is not associated with Schizophrenia or a Manic Episode.

Symptoms tend to peak during the late teenage years and early 20′s and may improve on their own by a person’s 40′s.

What causes someone to develop Antisocial Personality Disorder?

Personality disorders are chronic behavioral and relationship patterns that interfere with a person’s life over many years. To receive a diagnosis of antisocial personality disorder, a person must have exhibited behavior that qualifies for a diagnosis of conduct disorder during childhood.

The cause of antisocial personality disorder is unknown, but genetic factors and child abuse are believed to contribute to the development of this condition. People with an antisocial or alcoholic parent are at increased risk. Far more men than women are affected, and unsurprisingly, the condition is common in prison populations.

Fire-setting and cruelty to animals during childhood are linked to the development of antisocial personality.

What are the risk factors linked to Antisocial Personality Disorder?

Personality development is affected by genetic tendencies as well as environmental factors, such as childhood experiences. Most factors that increase the risk of developing antisocial personality relate to genetics and an abusive or neglectful childhood environment.

• Having suffered from child abuse
• Having a childhood environment of deprivation or neglect
• Having an antisocial parent
• Having an alcoholic parent
• Being involved in a group of peers that exhibit antisocial behavior
• Having an attention-deficit disorder
• Having a reading disorder

Paranoid Personality Disorder

Paranoid personality disorder (PPD) is one of a group of conditions called eccentric personality disorders. People with these disorders often appear odd or peculiar. People with PPD also suffer from paranoia, an unrelenting mistrust and suspicion of others, even when there is no reason to be suspicious. This disorder usually begins by early adulthood and appears to be more common in men than in women.

What are the symptoms of PPD?

People with PPD are always on guard, believing that others are constantly trying to demean, harm, or threaten them. These generally unfounded beliefs, as well as their habits of blame and distrust, might interfere with their ability to form close relationships. People with this disorder:

• Doubt the commitment, loyalty, or trustworthiness of others, believing others are using or deceiving them
• Are reluctant to confide in others or reveal personal information due to a fear that the information will be used against them
• Are unforgiving and hold grudges
• Are hypersensitive and take criticism poorly
• Read hidden meanings in the innocent remarks or casual looks of others
• Perceive attacks on their character that are not apparent to others; they generally react with anger and are quick to retaliate
• Have recurrent suspicions, without reason, that their spouses or lovers are being unfaithful
• Are generally cold and distant in their relationships with others, and might become controlling and jealous
• Cannot see their role in problems or conflicts, believing they are always right
• Have difficulty relaxing
• Are hostile, stubborn, and argumentative

What causes PPD?

The exact cause of PPD is not known, but it likely involves a combination of biological and psychological factors. The fact that PPD is more common in people who have close relatives with schizophrenia suggests a genetic link between the two disorders. Early childhood experiences—including physical or emotional trauma—are also suspected to play a role in the development of PPD.

Schizoid Personality Disorder

Schizoid personality disorder is one of a group of conditions called eccentric personality disorders. People with these disorders often appear odd or peculiar. People with schizoid personality disorder also tend to be distant, detached, and indifferent to social relationships. They generally are loners who prefer solitary activities and rarely express strong emotion. Although the names sound alike and they might have some similar symptoms, schizoid personality disorder is not the same thing as schizophrenia. Many people with schizoid personality disorder can function fairly well. They tend to choose jobs that allow them to work alone, such as night security officers and library or laboratory workers.

What are the symptoms of schizoid personality disorder?

People with schizoid personality disorder often are reclusive, organizing their lives to avoid contact with other people. Many never marry and continue to live with their parents as adults. The following are additional traits of people with this disorder:

• They do not desire or enjoy close relationships, even with family members.
• They choose solitary jobs and activities.
• They take pleasure in few activities, including sex.
• They have no close friends, except first-degree relatives.
• They have difficulty relating to others.
• They are indifferent to praise or criticism.
• They are aloof and show little emotion.
• They might daydream and/or create vivid fantasies of complex inner lives.

What causes schizoid personality disorder?

Little is known about the cause of schizoid personality disorder, but both genetics and environment are suspected to play a role. Some mental health professionals speculate that a bleak childhood where warmth and emotion were absent contributes to the development of the disorder. The higher risk for schizoid personality disorder in families of schizophrenics suggests that a genetic susceptibility for the disorder might be inherited.

How common is schizoid personality disorder?

It is difficult to accurately assess the prevalence of this disorder because people with schizoid personality disorder rarely seek treatment. Schizoid personality disorder affects men more often than women and is more common in people who have close relatives with schizophrenia. Schizoid personality disorder usually beings in early adulthood.

Histrionic Personality Disorder

Histrionic personality disorder is one of a group of conditions called dramatic personality disorders. People with these disorders have intense, unstable emotions and distorted self-images. For people with histrionic personality disorder, their self-esteem depends on the approval of others and does not arise from a true feeling of self-worth. They have an overwhelming desire to be noticed, and often behave dramatically or inappropriately to get attention. The word histrionic means “dramatic or theatrical.”  This disorder is more common in women than in men and usually is evident by early adulthood.

What are the symptoms of histrionic personality disorder?

In many cases, people with histrionic personality disorder have good social skills; however, they tend to use these skills to manipulate others so that they can be the center of attention.

A person with this disorder might also:

• Be uncomfortable unless he or she is the center of attention
• Dress provocatively and/or exhibit inappropriately seductive or flirtatious behavior
• Shift emotions rapidly
• Act very dramatically as though performing before an audience with exaggerated emotions and expressions, yet appears to lack sincerity
• Be overly concerned with physical appearance
• Constantly seek reassurance or approval
• Be gullible and easily influenced by others
• Be excessively sensitive to criticism or disapproval
• Have a low tolerance for frustration and be easily bored by routine, often beginning projects without finishing them or skipping from one event to another
• Not think before acting
• Make rash decisions
• Be self-centered and rarely show concern for others
• Have difficulty maintaining relationships, often seeming fake or shallow in their dealings with others
• Threaten or attempt suicide to get attention

What causes histrionic personality disorder?

The exact cause of histrionic personality disorder is not known, but many mental health professionals believe that both learned and inherited factors play a role in its development. For example, the tendency for histrionic personality disorder to run in families suggests that a genetic susceptibility for the disorder might be inherited. However, the child of a parent with this disorder might simply be repeating learned behavior. Other environmental factors that might be involved include a lack of criticism or punishment as a child, positive reinforcement that is given only when a child completes certain approved behaviors, and unpredictable attention given to a child by his or her parent(s), all leading to confusion about what types of behavior earn parental approval.

Narcissistic Personality Disorder

Pathological narcissism is a life-long pattern of traits and behaviours which signify infatuation and obsession with one’s self to the exclusion of all others and the egotistic and ruthless pursuit of one’s gratification, dominance and ambition.

As distinct from healthy narcissism which we all possess, pathological narcissism is maladaptive, rigid, persisting, and causes significant distress, and functional impairment.

Pathological narcissism was first described in detail by Freud in his essay “On Narcissism” (1915). Other major contributors to the study of narcissism are: Melanie Klein, Karen Horney, Franz Kohut, Otto Kernberg, Theodore Millon, Elsa Roningstam, Gunderson, and Robert Hare.

What is Narcissistic Personality Disorder (NPD)?

The Narcissistic Personality Disorder (NPD) (formerly known as megalomania or, colloquially, as egotism) is a form of pathological narcissism. It is a Cluster B (dramatic, emotional, or erratic) personality disorder. Other Cluster B personality disorders are the Borderline Personality Disorder (BPD), the Antisocial Personality Disorder (APD), and the Histrionic Personality Disorder (HPD). The Narcissistic Personality Disorder (NPD) first appeared as a mental health diagnosis in the DSM III-TR (Diagnostic and Statistical Manual) in 1980.

Diagnostic Criteria

The ICD-10, the International Classification of Diseases, published by the World Health Organisation in Geneva [1992] regards the Narcissistic Personality Disorder (NPD) as “a personality disorder that fits none of the specific rubrics”. It relegates it to the category“Other Specific Personality Disorders” together with the eccentric, “haltlose”, immature, passive-aggressive, and psychoneurotic personality disorders and types.

The American Psychiatric Association, based in Washington D.C., USA, publishes the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Text Revision (DSM-IV-TR) [2000] where it provides the diagnostic criteria for the Narcissistic Personality Disorder (301.81, p. 717).

The DSM-IV-TR defines Narcissistic Personality Disorder (NPD) as “an all-pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration or adulation and lack of empathy, usually beginning by early adulthood and present in various contexts”, such as family life and work.

The DSM specifies nine diagnostic criteria. Five (or more) of these criteria must be met for a diagnosis of Narcissistic Personality Disorder (NPD) to be rendered.

[In the text below, I have proposed modifications to the language of these criteria to incorporate current knowledge about this disorder. My modifications appear in bold italics.]

Proposed Amended Criteria for the Narcissistic Personality Disorder

• Feels grandiose and self-important (e.g., exaggerates accomplishments, talents, skills, contacts, and personality traits to the point of lying, demands to be recognised as superior without commensurate achievements);

• Is obsessed with fantasies of unlimited success, fame, fearsome power or omnipotence, unequalled brilliance (the cerebral narcissist), bodily beauty or sexual performance (the somatic narcissist), or ideal, everlasting, all-conquering love or passion;

• Firmly convinced that he or she is unique and, being special, can only be understood by, should only be treated by, or associate with, other special or unique, or high-status people (or institutions);

• Requires excessive admiration, adulation, attention and affirmation – or, failing that, wishes to be feared and to be notorious (Narcissistic Supply);

• Feels entitled. Demands automatic and full compliance with his or her unreasonable expectations for special and favourable priority treatment;

• Is “interpersonally exploitative”, i.e., uses others to achieve his or her own ends;

• Devoid of empathy. Is unable or unwilling to identify with, acknowledge, or accept the feelings, needs, preferences, priorities, and choices of others;

• Constantly envious of others and seeks to hurt or destroy the objects of his or her frustration. Suffers from persecutory (paranoid) delusions as he or she believes that they feel the same about him or her and are likely to act similarly;

• Behaves arrogantly and haughtily. Feels superior, omnipotent, omniscient, invincible, immune, “above the law”, and omnipresent (magical thinking). Rages when frustrated, contradicted, or confronted by people he or she considers inferior to him or her and unworthy.

Prevalence and Age and Gender Features

According to the DSM IV-TR, between 2% and 16% of the population in clinical settings (between 0.5-1% of the general population) are diagnosed with Narcissistic Personality Disorder (NPD). Most narcissists (50-75%, according to the DSM-IV-TR) are men.

We must carefully distinguish between the narcissistic traits of adolescents – narcissism is an integral part of their healthy personal development – and the full-fledge disorder. Adolescence is about self-definition, differentiation, separation from one’s parents, and individuation. These inevitably involve narcissistic assertiveness which is not to be conflated or confused with Narcissistic Personality Disorder (NPD).

Narcissistic Personality Disorder (NPD) is exacerbated by the onset of aging and the physical, mental, and occupational restrictions it imposes.

In certain situations, such as under constant public scrutiny and exposure, a transient and reactive form of the Narcissistic Personality Disorder (NPD) has been observed by Robert Milman and labelled “Acquired Situational Narcissism”.

There is only scant research regarding the Narcissistic Personality Disorder (NPD), but studies have not demonstrated any ethnic, social, cultural, economic, genetic, or professional predilection to it.

Comorbidity and Differential Diagnoses

Narcissistic Personality Disorder (NPD) is often diagnosed with other mental health disorders (“co-morbidity”), such as mood disorders,eating disorders, and substance-related disorders. Patients with Narcissistic Personality Disorder (NPD) are frequently abusive and prone to impulsive and reckless behaviours (“dual diagnosis”).

Narcissistic Personality Disorder (NPD) is commonly diagnosed with other personality disorders, such as the Histrionic, Borderline, Paranoid, and Antisocial Personality Disorders.

The personal style of those suffering from the Narcissistic Personality Disorder (NPD) should be distinguished from the personal styles of patients with other Cluster B Personality Disorders. The narcissist is grandiose, the histrionic coquettish, the antisocial (psychopath) callous, and the borderline needy.

As opposed to patients with the Borderline Personality Disorder, the self-image of the narcissist is stable, he or she are less impulsive and less self-defeating or self-destructive and less concerned with abandonment issues (not as clinging).

Contrary to the histrionic patient, the narcissist is achievements-orientated and proud of his or her possessions and accomplishments. Narcissists also rarely display their emotions as histrionics do and they hold the sensitivities and needs of others in contempt.

According to the DSM-IV-TR, both narcissists and psychopaths are “tough-minded, glib, superficial, exploitative, and unempathic”. But narcissists are less impulsive, less aggressive, and less deceitful. Psychopaths rarely seek narcissistic supply. As opposed to psychopaths, few narcissists are criminals.

Patients suffering from the range of obsessive-compulsive disorders are committed to perfection and believe that only they are capable of attaining it. But, as opposed to narcissists, they are self-critical and far more aware of their own deficiencies, flaws, and shortcomings.

Clinical Features of the Narcissistic Personality Disorder

The onset of pathological narcissism is in infancy, childhood and early adolescence. It is commonly attributed to childhood abuse and trauma inflicted by parents, authority figures, or even peers. Pathological narcissism is a defense mechanism intended to deflect hurt and trauma from the victim’s “True Self” into a “False Self” which is omnipotent, invulnerable, and omniscient. The narcissist uses the False Self to regulate his or her labile sense of self-worth by extracting from his environment narcissistic supply (any form of attention, both positive and negative).

There is a whole range of narcissistic reactions, styles, and personalities – from the mild, reactive and transient to the permanent personality disorder.

Patients with Narcissistic Personality Disorder (NPD) feel injured, humiliated and empty when criticized. They often react with disdain (devaluation), rage, and defiance to any slight, real or imagined. To avoid such situations, some patients with Narcissistic Personality Disorder (NPD) socially withdraw and feign false modesty and humility to mask their underlying grandiosity. Dysthymic and depressive disorders are common reactions to isolation and feelings of shame and inadequacy.

The interpersonal relationships of patients with Narcissistic Personality Disorder (NPD) are typically impaired due to their lack of empathy, disregard for others, exploitativeness, sense of entitlement, and constant need for attention (narcissistic supply).

Though often ambitious and capable, inability to tolerate setbacks, disagreement, and criticism make it difficult for patients with Narcissistic Personality Disorder (NPD) to work in a team or to maintain long-term professional achievements. The narcissist’s fantastic grandiosity, frequently coupled with a hypomanic mood, is typically incommensurate with his or her real accomplishments (the “grandiosity gap”).

Patients with Narcissistic Personality Disorder (NPD) are either “cerebral” (derive their Narcissistic Supply from their intelligence or academic achievements) or “somatic” (derive their Narcissistic Supply from their physique, exercise, physical or sexual prowess and romantic or physical “conquests”).

Patients with Narcissistic Personality Disorder (NPD) are either “classic” (meet five of the nine diagnostic criteria included in the DSM), or they are “compensatory” (their narcissism compensates for deep-set feelings of inferiority and lack of self-worth).

Some narcissists are covert, or inverted narcissists. As codependents, they derive their narcissistic supply from their relationships with classic narcissists.

Based on a survey of 1201 therapists and psychologists in clinical practice, Prof. Drew Westen of Emory University postulated the existence of three subtypes of narcissists:

1. High functioning or Exhibitionist: “(H)as an exaggerated sense of self-importance, but is also articulate, energetic, outgoing, and achievement oriented.” (The equivalent of the Cerebral narcissist).

2. Fragile: “(W)ants to feel important and privileged to ward off painful feelings of inadequacy and loneliness” (The equivalent of the Compensatory narcissist).

3. Grandiose or Malignant: “(H)as an exaggerated sense of self-importance, feels privileged, exploits others, and lusts after power.” (The equivalent of the Classic narcissist).