I have long struggled with hocd and pocd, but yesterday

Welcome to JustAnswer. My name is***** and I am an experienced psychologist here to assist. I am sorry to hear you are going through a difficult time considering if you are a Narccists or if your OCD is getting the worst of you forcing you to believe that you have a mental health condition that you don't really have. Let’s see if we can work through this…

The word narcissism gets tossed around a lot often to describe people who are selfie-taking, social media-obsessed people. Or people who have a high sense of self. But in the psychological world narcissism doesn’t mean self-love. It’s more accurate to say that people with narcissistic personality disorder (NPD) are in love with an idealized, grandiose image of themselves. And they’re in love with this inflated self-image precisely because it allows them to avoid deep feelings of insecurity. But propping up their delusions of grandeur takes a lot of work—and that’s where the dysfunctional attitudes and behaviours come in.

Narcissistic personality disorder involves a pattern of self-centred, arrogant thinking and behaviour, a lack of empathy and consideration for other people, and an excessive need for admiration. Others often describe people with NPD as cocky, manipulative, selfish, patronizing, and demanding. This way of thinking and behaving surfaces in every area of the narcissist’s life: from work and friendships to family and love relationships.

People with narcissistic personality disorder are extremely resistant to changing their behaviour, even when it’s causing them problems. Their tendency is to turn the blame on to others. What’s more, they are extremely sensitive and react badly to even the slightest criticisms, disagreements, or perceived slights, which they view as personal attacks. For the people in the narcissist’s life, it’s often easier just to go along with their demands to avoid the coldness and rages.

DSM CRITERIA FOR NPD:

The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits.

To diagnose a narcissistic personality disorder, the following criteria must be met:

A. Significant impairments in personality functioning manifest by:

1. Impairments in self-functioning (a or b): a. Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem. b. Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.

AND

2. Impairments in interpersonal functioning (a or b): a. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others. b. Intimacy: Relationships are largely superficial and exist to serve self-esteem regulation; mutuality is constrained by little genuine interest in others‟ experiences and predominance of a need for personal gain

B. Pathological personality traits in the following domain:

1. Antagonism, characterized by: a. Grandiosity: Feelings of entitlement, either overt or covert; self-centeredness; firmly holding to the belief that one is better than others; condescending toward others. b. Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking. C. The impairments in personality functioning and the individual‟s personality trait expression are relatively stable across time and consistent across situations. D. The impairments in personality functioning and the individual‟s personality trait expression are not better understood as normative for the individual‟s developmental stage or socio-cultural environment. E. The impairments in personality functioning and the individual‟s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma)

WHAT IS THE CAUSE OF NPD:

All personality disorders are inheritable, at least to some degree. One 2008 study involving twins found that hereditary influences were about 25 percent responsible for narcissistic traits in adults, with the remaining percentage determined by specific environmental influences, meaning mainly experiences during childhood.

Among the environmental causes of NPD, the impact of parenting stands out:

Parenting styles that are overly authoritarian and perfectionist. This can damage a child’s self-esteem, putting them under constant pressure to meet unrealistic standards for performance. When this happens, the child may eventually retreat into narcissism, supporting his or her fragile ego with assumptions of infallibility and superiority.

Inconsistent parenting that veers back and forth between neglectful or critical and overly indulgent. Immersion in such an unpredictable environment can cause confusion and insecurity in a child. To bring clarity, they may don a cloak of narcissism to create a grand and important self-image.

Exposure to any type of physical, emotional, or sexual abuse in childhood from any source. This can include actions by parents or other adult caregivers or excessive bullying or teasing by peers. If no therapeutic intervention to deal with the abuse is offered, the victim may adopt narcissistic attitudes to help suppress the traumatic memories and counteract their devastating effects.

In the end, a retreat into narcissism is an ineffective strategy for coping with trauma. The low self-esteem, lack of self-confidence, and damaged self-image that are fundamental to narcissism will remain repressed and denied, creating an internal split between conscious beliefs and unconscious motivations that cause the suffering and dysfunction to continue.

TREATMENT:

Most mental health conditions are treated with a combination of therapy and medication. But personality disorders, including NPD, do not respond to medication. If drugs are prescribed, they will be used to treat the symptoms of any co-occurring disorders that might be present.

For people with NPD, the therapeutic approach that yields the best results is one that involves individual, group and family therapy. The person with NPD must also want to be invested in the process.

Ongoing and intensive long-term therapy help NPD sufferers come to grips with how their condition has damaged their lives and kept them from reaching their full potential, and the input of peers and loved ones can add context, depth, and reinforcement to these realizations. Mental health therapists will not attack the condition openly or aggressively. The therapeutic process must be approached deliberately and with caution, so the patient is not pushed too far too fast.

Working together, therapists and narcissistic patients will identify the attitudes and behaviours that create stress, conflict, and dissatisfaction in life. As recovery progresses, therapists will encourage NPD sufferers to take constructive action to ameliorate the negative impact of their narcissistic symptoms, providing practical advice and instruction that can help them do so.

Therapists working with narcissistic patients must strive to create an atmosphere where judgmental attitudes are excluded and the focus is strictly solution-oriented. This is important since a positive approach in therapy can build trust and contribute to a more effective dialogue between doctor and patient.

Evidence-based therapy programs for patients diagnosed with a narcissistic personality disorder often include:

Cognitive Behavioural Therapy Through multiple sessions of CBT, narcissistic personality disorder sufferers can learn to replace grandiose and distorted thoughts with more positive and realistic ideas and self-assessments.

Psychodynamic Therapy In psychodynamic therapy sessions, patients with NPD will plumb the depths of their past experiences, to evaluate the effects of problematic relationships on their lives and to examine unconscious assumptions about themselves and others that support narcissistic attitudes.

Family Therapy Narcissistic behaviour impacts families as much as it impacts individuals, and involving loved ones in the healing and recovery process can help NPD sufferers understand the true ramifications of their self-centred behaviour.

Since people with narcissistic personality disorder are often resistant to therapy, especially in the early stages, mental health professionals must work overtime to ensure their NPD patients are fully on board with every aspect of their treatment plan. Cooperation doesn’t come naturally for narcissists, but it is something they must learn to do if they are to have any hope of recovery.

I hope the above serves to offer some context regarding NPD and understanding of the process of diagnosis, origins and treatment.

Wishing you all of the very best!