Background

In the previous submission, we learned that a person has to have impairments in personality (self and interpersonal) as well as have pathological personality traits (erratic traits that society rejects that aren’t optimal to functioning) present in order for us to use the “disorder” label.  These impairments in personality are at the ‘self’ level affecting identity and self-direction as well as the ‘interpersonal’ level where empathy and intimacy play a role (see Table 2).  Here we will use the diagnostic criteria we see in DSM 5 part II (see Table 1) to point towards diagnoses based on the trait model but will also integrate section III’s model since it is much more insightful.

I’m sure I can read on the practice of how to diagnose and assess until I turn blue in the face but to truly be a good clinician takes actual experience, which I don’t have.  But I’d argue that in some sense I’m actually in a much better position to making an accurate diagnosis than a practitioner is as I have observations that stretch over ten years, which exclude the narcissist’s confessions to a therapist which are often contrived and of little value.  In fact, I am providing a very rare opportunity at looking at how a narcissist thinks because NPD is the least studied of personality disorders and many variations exist making it confusing and difficult to diagnose.

Method Used

Unfortunately, there seems to be a lack of rigor and protocol to diagnosing that confirms my overall impression that I have had on the profession, and I say this in the most respectful way because I know it’s a social and behavioral science making variables more difficult to capture and measure.  But look at the first criterion (Table 1) and notice that there’s nothing to distinguish between how strong (severity or magnitude) or how often (frequency) the effect is.  So this makes me concerned about conflating the disorder with just having the trait.

And besides, there is no attempt on capturing how often these nine tendencies show up over time, there’s also no way of characterizing the quality of how the traits are expressed under certain conditions which may be important.  I did, however, find a questioner that puts it in on a five-point scale ranging from very often to never, which I decided to use.  But we don’t have access to the person’s personal thoughts and feelings, and she is socially skilled enough to know how to hide her unattractive ego with others.  So what are we relying on as data?

What I did was estimated an answer shown in the criteria scale below under Table 1 based on the degree and frequency of her demonstrating these traits as seen in her actual behavior and in odd things that she’s uttered.  These utterances were in unique contexts that when extracted, I would argue, give lots of information about her inner workings.  She also had a very well hidden but highly developed ego, which could be quite disturbing, often coming across as if that were her authentic-self making all other sides to her seem but a facade.  

It was in these moments of egotistical truth, however, that revealed a highly insecure person that was very much attuned to my place, your place, and her place in the social hierarchy so as she can best strategize her moves in her limitless quest for power and attention.

Table 1. Trait Model (DSM 5 section II)

1. Has a grandiose sense of self-importance. (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, ideal love.  
3. 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).
4. Requires excessive admiration.
5. Is interpersonally exploitative. (i.e., takes advantage of others to achieve his or her own ends)
6. Has a sense of entitlement.  (i.e., unreasonable expectation of especially favorable treatment or automatic compliance with his or her expectations)
7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
8. Is often envious of others or believes that others are envious of him or her.  
9. Shows arrogant, haughty behaviors and attitudes.

Explanation of Traits

The essence of grandiosity I take as to be the desire to feel “important” which can easily fall into a feeling of superiority.  The emotions involved here are those of the self-conscious type—namely pride and shame—which help us to function in social situations by making us aware of how we come across to others.  So important only makes sense in social contexts because it has to do with how we rank relative to one another.  And one of the reinforcers of feeling important—making you want to do it—is to feel the emotion of pride, but once you start comparing yourself in a superior way, then you will feel the inflated pride of a narcissist known as hubris.

The next trait is having the tendency of idealizing, fantasizing, or romanticizing.  The kernel in these activities has to do once again with feeling important, special, and powerful.  What happens is that we fantasize how perfection would be in the future – say the ownership of many houses or to be in the presence of a perfect lover—and we relish those feelings of pride and feelings of being special through our imaginations.

The third trait has to do with how important it is to associate with high-status others to affect your self-esteem.  This is where the trait model found in section II shows its limitations, so I will mention section III, the hybrid model, shown in Table 2 below, that works with dimensions instead of traits that could be integrated into this analysis for more insight.

Table 2. Hybrid Model (DSM 5 section III)

A. Moderate or greater impairment in personality functioning, manifested by characteristic difficulties in two or more of the following four areas: