Narcissistic Personality Disorder

by Alison L Miller, MSN, PMH-BC, FAIS

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Personality disorders tend to show up early in life (childhood) but are not diagnosed formally until after the age of 18, giving the child the chance to change their environment, and therefore their responses to that environment. But once an individual reaches 18, and there is a persistent--day in, day out, inflexible--pattern of behavior and thought that is considered unhealthy, dysfunctional, and/or aberrant, and the individual is seen by a licensed psychiatric provider, the diagnosis of a personality disorder may be made.4

Those with narcissistic personality disorder are especially difficult to deal with, because their entire framework is that no one is smarter or more insightful than they are. This includes experienced, trained clinicians. The refrain in their minds is usually something like, "Well obviously this person is a moron for not understanding how special I am, how important my needs are." This is mental fortress that is almost always impenetrable.

For instance, when someone with NPD is fired with cause, and they are confronted with their infractions (which can include acts that are outright illegal) with proof, an individual with NPD will shrug and dismiss the accusations as jealousies, a lack of "vision,"or simply a lack of intelligence in understanding the purpose and value of their actions.

One thing that will not be on the exam but which I want to drop in here as a side note: one thing about people with NPD is that when they feel they have been slighted or insulted in some way, they often become focused on "balancing the scales" through revenge. This can include everything from calling that person names to others and attacking their reputation to overt violence, such as sexual or physical assault.

For more support in passing ANCC's PMH-BC exam, go to pmhrn.com.