Mirror Mirror on the Wall - An Insight into Narcissistic Personality Disorder

Having a conversation with a person with an inflated ego is always a very tiresome experience. We are constantly pushed into praising the other person, for criticism is not well received and often disregarded. Narcissism refers to the pursuit of gratification from the egoistic admiration of one’s own physical or mental attributes. 

Narcissistic personality disorder (NPD) is characterized by a lack of empathy as well as a need for admiration and a pervasive pattern of grandiosity [1]. It has prevalence rates of up to 6% in the general population and pathological narcissism is considered a severe mental disorder, associated with significant functional impairments [2].

What Leads to NPD?
Although it is difficult to pinpoint a single cause for the disorder, it is thought to result from extremes in child rearing. On the one hand, it could arise from excessive pampering. On the other, neglect, abuse or trauma inflicted by the parents or other authority figures during childhood could also lead to narcissism, which is usually evident by early adulthood. As a consequence, narcissistic individuals always need people around them, as their entire sense of self-worth is dependent on the admiration of others.

The Neurobiology of Narcissism
From a neurobiological perspective, studies with people suffering from NPD have led to interesting findings. Ritter et al. showed that patients with NPD had severe deficits in emotional empathy although they had intact cognitive empathy.  Emotional empathy requires subjects to rate how much of the emotion in a picture they feel when they view an emotional picture, while cognitive empathy is determined by asking subjects to infer the mental state of a person in the picture [3]. Another study using functional magnetic resonance imaging found that healthy subjects scoring high on a Narcissism Inventory also showed significantly decreased activation during an empathy task, especially in the right anterior insula [4]. Psychotherapy and medication are the currently available treatment options. Identifying the feelings of vulnerability and impaired self-reflection as the core features of the disorder can lead to better psychological treatments.

[1] American Psychiatric Association, 2000
[2] Stinson et al, J Clin Psychiatry, 2008
[3] Ritter et al, Psychiatry Res, 2011
[4] Fan et al, Psychological Medicine, 2011

by Apoorva Rajiv Madipakkam
This article originally appeared 2014 in CNS Volume 7, Issue 2, Neuroscience of Love