First off, your second link there hasn't been reviewed since 2010. I got a case study from 2013, an attempt to change the DSM for narcissism due to it's actual granularity and subtypes from 2008, and a letter to the journal of Indian Pscy med from 2012.
- Seishin Shinkeigaku Zasshi. 2013;115(4):363-71.
[A case of major depressive disorder barely distinguishable from
narcissistic personality disorder].
[Article in Japanese]
Saito S, Kobayashi T, Kato S.
Department of Psychiatry, Jichi Medical University.
The recent increase in cases of depression with a narcissistic
tendency, especially among young individuals, has been pointed out.
When the narcissistic tendency is conspicuous, patients may be treated
for a personality disorder or pervasive developmental disorder, and
not for a mood disorder. A case is described of a man in his late
twenties who developed depression due to his failure in research work
and job hunting, and, after a time, due to the break off of his
engagement with his fiancée, manifested with narcissistic symptoms
including an exaggerated opinion of himself, a sense of entitlement,
interpersonal exploitation, lack of empathy, strong feelings of envy,
and an extrapunitive tendency. He was regarded at the start of
treatment as having narcissistic personality disorder. However,
persevering treatment, mainly with supportive psychotherapy and
pharmacotherapy including antidepressants (high dose of maprotiline
combined with low dose of mirtazapine), sodium valprote and
aripiprazole, finally improved not only his depressive symptoms, but
also the symptoms regarded as a deriving from a personality disorder.
He presented fierce anger and aggression regarded as a mixed state,
and showed the rapid improvement in his depressive state after
hospitalization, which we considered to show potential bipolarity. We
diagnosed the patient with narcissistic depression, emphasizing the
aspect which suggested a mood disorder, such as the episodic presence
of narcissistic symptoms as long as a depressive state resided, his
circular, recursive discourse, and his potential bipolarity. To
accurately evaluate the aspect of mood disorders which patients
appearing to show personality disorders have, it is considered useful
to grasp a patient's condition from the viewpoint of a personality
structure and viable dynamics. From a therapeutic standpoint, we
suggest the importance of simple but persevering psychotherapy and a
sufficient quantity of antidepressant medication for patients with
depression, even if they are thought to have a personality disorder.
PMID: 23789317 [PubMed - indexed for MEDLINE]
Hmm well they seem to note initially that the converse is true in the first sentence. We'll investigate why this is true soon too and the reasons for it.
Before even reading this, I hypothesized someone with bipolar disorder could have this type of problem...and sure enough...they mention the patient as potentially having it.
This one is back from 2008. It seems like they were having some trouble with the DSM labeling of the disorder back then. Apparently there are several different subtypes of narcissistic disorder, which could definatly seem viable. So, so far your answer is 'sometimes'.
- Am J Psychiatry. 2008 Nov;165(11):1473-81. doi: 10.1176/appi.ajp.2008.07030376. Epub 2008 Aug 15.
Refining the construct of narcissistic personality disorder:
diagnostic criteria and subtypes.
Russ E, Shedler J, Bradley R, Westen D.
Department of Psychology, Emory University, Atlanta, GA, USA.
Am J Psychiatry. 2008 Nov;165(11):1379-82.
OBJECTIVE: Narcissistic personality disorder has received relatively
little empirical attention. This study was designed to provide an
empirically valid and clinically rich portrait of narcissistic
personality disorder and to identify subtypes of the disorder.
A random national sample of psychiatrists and clinical psychologists
(N=1,201) described a randomly selected current patient with
personality pathology. Clinicians provided detailed psychological
descriptions of the patients using the Shedler-Westen Assessment
Procedure-II (SWAP-II), completed a checklist of axis II diagnostic
criteria, and provided construct ratings for each axis II personality
disorder. Descriptions of narcissistic patients based on both raw and
standardized SWAP-II item scores were aggregated to identify,
respectively, the most characteristic and the most distinctive
features of narcissistic personality disorder.
RESULTS: A total of 255
patients met DSM-IV criteria for narcissistic personality disorder
based on the checklist and 122 based on the construct ratings; 101
patients met criteria by both methods. Q-factor analysis identified
three subtypes of narcissistic personality disorder, which the authors
labeled grandiose/malignant, fragile, and
high-functioning/exhibitionistic. *Core features of the disorder
included interpersonal vulnerability and underlying emotional
distress, along with anger, difficulty in regulating affect, and
interpersonal competitiveness, features that are absent from the
DSM-IV description of narcissistic personality disorder.*
These findings suggest that DSM-IV criteria for narcissistic
personality disorder are too narrow, underemphasizing aspects of
personality and inner experience that are empirically central to the
disorder. The richer and more differentiated view of narcissistic
personality disorder suggested by this study may have treatment
implications and may help bridge the gap between empirically and
clinically derived concepts of the disorder.
PMID: 18708489 [PubMed - indexed for MEDLINE]
And the story gets more complicated...to the point where there seem like many different types of treatment and just problems with therapists dealing with narcissists.
Core features of the disorder
- included interpersonal vulnerability and underlying emotional
- distress, along with anger
- difficulty in regulating affect
- interpersonal competitiveness
Looks like your question's answer is getting split up in many different ways.
I found this interesting letter that was sent to the Indian Journal of Psych Med. It looks like there are specific type of strategies for dealing with specific types of issues....like for relationship issues there's one way, for other types...there's another.
I'll bold the interesting parts.
Indian J Psychol Med. 2012 Oct-Dec; 34(4): 403–404.
Demystifying Paradoxical Characteristics of Narcissistic Personality Disorder
Gildersleeve Queensland University of Technology, Brisbane,
Queensland, Australia Address for correspondence: Dr. Matthew
Gildersleeve, Queensland University of Technology, Brisbane,
This letter is aimed for psychotherapy clinicians and researchers who
should acknowledge the relationship linking Kohut's self-psychology
and Glasser's Choice theory that can demystify relationship
difficulties and mental health problems in narcissistic personality
disorder (NPD). NPD is commonly experienced interpersonally by others
as insufferable, pompous, and un-empathic. NPD persons have been
identified to possess giant self-centeredness, a certainty that they
own supreme personality, and their humiliation of others makes them
intolerable for interpersonal relations. Importantly, Heinz Kohut's
legacy to psychology is known as self-psychology and was centered
principally on narcissistic personality development and treatment.
Suboptimal psychological development is thought to arise when maternal
compassion is discriminately substandard. As a result, the
narcissistic self constructs a defense against the helplessness of a
hurtful world. Kohut cited in Banai et al. called the
compassion required from maternal figures as “self-object needs”
because these needs develop the self-image and are provided by
external objects. (Oh wow, it seems like they're talking about entitled rich kid's attitudes, that's kinda funny, interesting).
By not receiving necessary self-object transferences through decisive
epochs in development, the young individual cannot build the
competence to control self-respect or construct a positive
self-image. *Consequently, the child, now an adult, depends on other
humans to construct their self-image. The self-object transferences
received as an adult provide a feeling of significance, which was not
established during child development. However, NPD persons are
apprehensive of meeting self-object absence as an adult. In order
to feel the control of their fate, NPD persons present a mindset of
dominance in the interpersonal sphere. As a result of this
authoritarian manner, persons with NPD typically have a record of
numerous unsuccessful relationships.*
Go to: PARADOXICAL CHARACTERISTICS IN NARCISSISTIC PERSONALITY
DISORDER Thus far, this letter has acknowledged that NPD persons rely
heavily on self-object transferences to develop a positive self-image.
The behavioral characteristics of NPD persons reflect this need and
are well documented. However, what is paradoxical about these
behavioral characteristics is that instead of behaving in a way to
increase the chance of receiving self-object transferences in
relationships, NPD individuals act in a way to reduce that possibility
by destroying interpersonal relations.
(So not only have we seen narcissists become depressed...they also have the propentencity to do things in relationships that sabotage them....which may then lead to this depression.)
Glasser has specified relationship building and destroying behavior
in a grand detail in his Choice theory. “Seven Caring Habits” and
“Seven Deadly Habits” offer superb rules for how psychotherapists
should interact with clients to enhance the likelihood that these
individuals use caring interpersonal habits to attain optimal mental
health. It is evident from the literature that NPD behavioral
characteristics reflect the “Seven Deadly Habits.” Glasser's Seven
Caring Habits are Supporting, Encouraging, Listening, Accepting,
Trusting, Respecting, Negotiating differences and the Deadly Habits
are Criticizing, Blaming, Complaining, Nagging, Threatening,
Punishing, Bribing, or Rewarding to Control.
Go to: CHOICE THEORY The writing of Kohut and advocates of
self-psychology argue that the feeling of love, belonging, closeness,
and connectedness with other humans are essential for individuals with
NPD who requires self-object transferences. Unfortunately, the
pushing, demanding actions (Seven Deadly Habits or External Control
Psychology) being used by NPD persons destroy relationships and
therefore prevents self-object needs being met. When external control
is used by NPD persons, it will destruct the capacity of one or both
individuals to locate contentment, eventually resulting in severed
relationships. This interpersonal disengagement is argued to be the
foundation for the majority of human mental illness. Choice Theory
and the Seven Caring Habits are offered to replace external control
psychology and the Seven Deadly Habits to preserve relationships
and optimal mental health.
External Control Psychology is an attempt to control others to act in
a way they do not want to. This ideology of a person who uses
external control does not permit individuals outside the self to
formulate preference about individual freedom, and advocates that
other individuals should be punished to modify their behavior to
attain the controllers' needs. The “Deadly Habits” demolishes
individual freedom of the oppressed individual and therefore acts to
disconnect relationships, as freedom has been identified as one of the
basic human needs.
Consequently, a central thesis of Choice theory is that the only
individual one can be in command of is themselves. If the
individual believes they can command other humans, then they will
encounter anger and irritation leading to mental illness. Anger,
irritation, and mental illness will also arise if the individual
believes that other humans can command them and then externalizes
blame to the perceived controller for undesirable events. For that
reason, it is vital for the NPD individual to focus on internal
control of their own choices and to value the rights of other people
who have their own needs.
In conclusion, it is important that the caring habits be taught to the
NPD client, once a therapist has identified an individual with strong
self-object needs and who meets the criteria for NPD. Using Choice
theory, the psychotherapist directs an individual toward fulfilling
interpersonal relationships and educates the person to relate in more
helpful modes using internal control psychology. The better NPD
persons are proficient at bonding and comprehending other individual
needs, the better prospect they possess to receive positive
self-object transferences and happiness.
Go to: ACKNOWLEDGMENTS Thank you to Amy-lee Weisse for constructive
discussion and invaluable guidance.
Go to: REFERENCES
1. Millon T, Millon CM, Meagher S. Hoboken, New Jersey: John Wiley & Sons; 2012. The Narcissistic Personality. Personality Disorders in
Modern Life; p. 330.
2. Kohut H. Chicago: University of Chicago Press; 2011. Introductory Considerations. The Analysis of the Self: A Systematic Approach to the
Psychoanalytic Treatment of Narcissistic Personality Disorders; p. 1.
3. Banai E, Mikulincer M, Shaver PR. “Selfobject” needs in kohut's self psychology: Links with attachment, self-cohesion, affect
regulation, and adjustment. Psychoanal Psychol. 2005;22:224–60.
4. McLean J. Psychotherapy with a Narcissistic Patient Using Kohut's Self Psychology Model. Psychiatry. 2007;4:40–47. [PMC free article]
5. Silverstein ML. Washington, DC: American Psychological Association; 2007. Narcissitic Personality Disorder, Disorders of the Self: A Personality-Guided Approach; p. 27.
6. Glasser Bloomington: IUniverse; 2011. Replacing External Control With The New Choice Theory Psychology. Take Charge of Your Life: How
to Get What You Need with Choice-Theory Psychology; p. 8.
7. Strack Hoboken, New Jersey: John Wiley & Sons; 2005. Self Psychological Foundations of Personality Disorders. Handbook of
Personology and Psychopathology; p. 181.
8. Glasser , Glasser New York: Harper Collins; 2007. External Control Can Kill a Marriage. Eight Lessons for a Happier Marriage; p. 11.
Linkback here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662146/
So, it looks like there's alot of stuff going on with Narcissists. Or what they call "NPD."
As for my conclusions:
NPD or (Perceived NPD) or actually scientists are still trying to figure it out I'm going to put into three categories that even have subcategories.
1) Being the center of attention and always getting what you wanted
while growing up...only to realize when it times come to get a job
that doesn't exist anymore - which can admittedly be a difficult
shift for someone to have to make. This could also stem from
derivatives of this. Obviously would say psychopathology here and environmental influencers are important players.**
The affects of this seem to appear as relationship issues mostly - as
they have developed a certain "expectation for this or that" which
puts stress on their mate....whom then eventually leaves
them....which then causes them to be a depressed narcissist. This
cycle also seems to repeat itself although methods are suggested to
help treat a patient with this disorder in the last piece of
2) Genuinely having some subtype of NPD that is more than just psychopathologically based.
This goes back to that 2nd study where they were trying to identify the subtypes for the DSM definition. These adjectives don't seem to describe someone who would necessarily fit into category #1, although they partially seem to discribe someone who would fit into my 3rd category - someone who is simply bipolar and has a "narcissistic mania." And yes, I just made that medical diagnosis up.
Q-Type Analysis (the authors labeled these as the three subtypes):
Core features of the disorder (NPD)
- included interpersonal vulnerability and underlying emotional
- distress, along with anger
- difficulty in regulating affect
- interpersonal competitiveness
So I actually don't really believe many #1's would fit into this #2 category I have set up due to the lack of focus on problems in certain types of relationships (they mention interpersonal failures...but not as directly).
I'd say these are most likely people with a true "NPD" pathology - with a couple bipolar's mixed in depending upon if their methodologies were very affective at weeding them out and since it's a Q-type analysis...I'd feel somewhat unconfident about that.
3) Someone who is bipolar and when they have their manic episode, they become narcissistic. Obviously they'd go up and down and have all sorts of fun problems.
Answer to your question:
They can be both, either/or, have it depend upon things like interpersonal issues because they feel like the world owes them something. Apparently the pathology of narcissism is a very complex thing to figure out or put any sort of hard and fast label on. It could be caused by one's psychology from how they were raised or a genuine mental disorder of a physiological kind. There's also problems with distinguishing it from bipolar disorder (although I'd say if someone had bipolar disorder then they'd probably know it).