Narcissistic Personality Disorder and the Social Work Exam
For details on all of these, take a look at PsychCentral’s summaries. But first, let’s zoom in on Cluster B and a recently much-discussed diagnosis: NPD.
A woman tells a social worker that she believes her husband, a successful businessman, is “a clinical narcissist.” She says he’s “completely obsessed with himself.” Which of the following can the social worker tell the woman is a common symptom of narcissistic personality disorder?
A. Discomfort in situations in which he or she is not the center of attention.
B. Is unwilling to recognize or identify with the feelings or needs of others.
C. Inappropriate, intense anger or difficulty controlling anger.
D. Repeated lying, use of aliases, or conning others for personal profit or pleasure.
What do you say?
If you know the cluster B diagnoses in some detail, the answer comes much more easily. All but one of the listed symptoms come from other cluster B disorders. Let’s take them one at a time:
A. sounds a lot like NPD. Needing to be the center of attention. But it’s not. It’s a criteria for histrionic personality disorder. Wait, really? Yep. Histrionic personality disorder is characterized by “a pervasive pattern of excessive emotionality and attention seeking…” It’s attention-focused, not self-importance focused.
D., repeated lying for profit or pleasure, sounds like NPD too, but, this one is a criterion for antisocial personality disorder (“A pervasive pattern of disregard for and violation of the rights of others…”). NPD can include taking advantage of others, but not necessarily outright, repeated lying, conning, or using aliases.
C., anger problems, sounds a little like NPD too. But it’s more indicative of BPD (“a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity”)–and that’s where that criterion comes form.
Which leaves…the correct answer! B., lack of empathy. For diagnosis of NPD, five of nine possible criteria have to be exhibited. Here are the full nine: