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Monday, December 13, 2021

Consequentialism

From Wikipedia, the free encyclopedia
 
Every advantage in the past is judged in the light of the final issue. — Demosthenes

Consequentialism is a class of normative, teleological ethical theories that holds that the consequences of one's conduct are the ultimate basis for judgment about the rightness or wrongness of that conduct. Thus, from a consequentialist standpoint, a morally right act (or omission from acting) is one that will produce a good outcome. Consequentialism, along with eudaimonism, falls under the broader category of teleological ethics, a group of views which claim that the moral value of any act consists in its tendency to produce things of intrinsic value. Consequentialists hold in general that an act is right if and only if the act (or in some views, the rule under which it falls) will produce, will probably produce, or is intended to produce, a greater balance of good over evil than any available alternative. Different consequentialist theories differ in how they define moral goods, with chief candidates including pleasure, the absence of pain, the satisfaction of one's preferences, and broader notions of the "general good".

Consequentialism is usually contrasted with deontological ethics (or deontology), in that deontology, in which rules and moral duty are central, derives the rightness or wrongness of one's conduct from the character of the behaviour itself rather than the outcomes of the conduct. It is also contrasted with virtue ethics, which focuses on the character of the agent rather than on the nature or consequences of the act (or omission) itself, and pragmatic ethics which treats morality like science: advancing socially over the course of many lifetimes, such that any moral criterion is subject to revision.

Some argue that consequentialist theories (such as utilitarianism) and deontological theories (such as Kantian ethics) are not necessarily mutually exclusive. For example, T. M. Scanlon advances the idea that human rights, which are commonly considered a "deontological" concept, can only be justified with reference to the consequences of having those rights. Similarly, Robert Nozick argued for a theory that is mostly consequentialist, but incorporates inviolable "side-constraints" which restrict the sort of actions agents are permitted to do. Derek Parfit argued that in practice, when understood properly, rule consequentialism, Kantian deontology and contractualism would all end up prescribing the same behavior.

Forms of consequentialism

Utilitarianism

Jeremy Bentham, best known for his advocacy of utilitarianism

Nature has placed mankind under the governance of two sovereign masters, pain and pleasure. It is for them alone to point out what we ought to do, as well as to determine what we shall do. On the one hand the standard of right and wrong, on the other the chain of causes and effects, are fastened to their throne. They govern us in all we do, in all we say, in all we think...

— Jeremy Bentham, The Principles of Morals and Legislation (1789) Ch I, p 1

In summary, Jeremy Bentham states that people are driven by their interests and their fears, but their interests take precedence over their fears; their interests are carried out in accordance with how people view the consequences that might be involved with their interests. Happiness, in this account, is defined as the maximization of pleasure and the minimization of pain. It can be argued that the existence of phenomenal consciousness and "qualia" is required for the experience of pleasure or pain to have an ethical significance.

Historically, hedonistic utilitarianism is the paradigmatic example of a consequentialist moral theory. This form of utilitarianism holds that what matters is the aggregate happiness; the happiness of everyone, and not the happiness of any particular person. John Stuart Mill, in his exposition of hedonistic utilitarianism, proposed a hierarchy of pleasures, meaning that the pursuit of certain kinds of pleasure is more highly valued than the pursuit of other pleasures. However, some contemporary utilitarians, such as Peter Singer, are concerned with maximizing the satisfaction of preferences, hence preference utilitarianism. Other contemporary forms of utilitarianism mirror the forms of consequentialism outlined below.

Rule consequentialism

In general, consequentialist theories focus on actions. However, this need not be the case. Rule consequentialism is a theory that is sometimes seen as an attempt to reconcile consequentialism with deontology, or rules-based ethics—and in some cases, this is stated as a criticism of rule consequentialism. Like deontology, rule consequentialism holds that moral behavior involves following certain rules. However, rule consequentialism chooses rules based on the consequences that the selection of those rules has. Rule consequentialism exists in the forms of rule utilitarianism and rule egoism.

Various theorists are split as to whether the rules are the only determinant of moral behavior or not. For example, Robert Nozick held that a certain set of minimal rules, which he calls "side-constraints," are necessary to ensure appropriate actions. There are also differences as to how absolute these moral rules are. Thus, while Nozick's side-constraints are absolute restrictions on behavior, Amartya Sen proposes a theory that recognizes the importance of certain rules, but these rules are not absolute. That is, they may be violated if strict adherence to the rule would lead to much more undesirable consequences.

One of the most common objections to rule-consequentialism is that it is incoherent, because it is based on the consequentialist principle that what we should be concerned with is maximizing the good, but then it tells us not to act to maximize the good, but to follow rules (even in cases where we know that breaking the rule could produce better results).

In Ideal Code, Real World, Brad Hooker avoids this objection by not basing his form of rule-consequentialism on the ideal of maximizing the good. He writes:

[T]he best argument for rule-consequentialism is not that it derives from an overarching commitment to maximise the good. The best argument for rule-consequentialism is that it does a better job than its rivals of matching and tying together our moral convictions, as well as offering us help with our moral disagreements and uncertainties.

Derek Parfit described Hooker's book as the "best statement and defence, so far, of one of the most important moral theories."

State consequentialism

It is the business of the benevolent man to seek to promote what is beneficial to the world and to eliminate what is harmful, and to provide a model for the world. What benefits he will carry out; what does not benefit men he will leave alone.

— Mozi, Mozi (5th century BC) Part I

State consequentialism, also known as Mohist consequentialism, is an ethical theory that evaluates the moral worth of an action based on how much it contributes to the welfare of a state. According to the Stanford Encyclopedia of Philosophy, Mohist consequentialism, dating back to the 5th century BCE, is the "world's earliest form of consequentialism, a remarkably sophisticated version based on a plurality of intrinsic goods taken as constitutive of human welfare."

Unlike utilitarianism, which views utility as the sole moral good, "the basic goods in Mohist consequentialist thinking are...order, material wealth, and increase in population." During the time of Mozi, war and famine were common, and population growth was seen as a moral necessity for a harmonious society. The "material wealth" of Mohist consequentialism refers to basic needs, like shelter and clothing; and "order" refers to Mozi's stance against warfare and violence, which he viewed as pointless and a threat to social stability. In The Cambridge History of Ancient China, Stanford sinologist David Shepherd Nivison writes that the moral goods of Mohism "are interrelated: more basic wealth, then more reproduction; more people, then more production and wealth...if people have plenty, they would be good, filial, kind, and so on unproblematically."

The Mohists believed that morality is based on "promoting the benefit of all under heaven and eliminating harm to all under heaven." In contrast to Jeremy Bentham's views, state consequentialism is not utilitarian because it is not hedonistic or individualistic. The importance of outcomes that are good for the community outweigh the importance of individual pleasure and pain. The term state consequentialism has also been applied to the political philosophy of the Confucian philosopher Xunzi. On the other hand, "legalist" Han Fei "is motivated almost totally from the ruler's point of view."

Ethical egoism

Ethical egoism can be understood as a consequentialist theory according to which the consequences for the individual agent are taken to matter more than any other result. Thus, egoism will prescribe actions that may be beneficial, detrimental, or neutral to the welfare of others. Some, like Henry Sidgwick, argue that a certain degree of egoism promotes the general welfare of society for two reasons: because individuals know how to please themselves best, and because if everyone were an austere altruist then general welfare would inevitably decrease.

Ethical altruism

Ethical altruism can be seen as a consequentialist theory which prescribes that an individual take actions that have the best consequences for everyone except for himself. This was advocated by Auguste Comte, who coined the term altruism, and whose ethics can be summed up in the phrase "Live for others."

Two-level consequentialism

The two-level approach involves engaging in critical reasoning and considering all the possible ramifications of one's actions before making an ethical decision, but reverting to generally reliable moral rules when one is not in a position to stand back and examine the dilemma as a whole. In practice, this equates to adhering to rule consequentialism when one can only reason on an intuitive level, and to act consequentialism when in a position to stand back and reason on a more critical level.

This position can be described as a reconciliation between act consequentialism—in which the morality of an action is determined by that action's effects—and rule consequentialism—in which moral behavior is derived from following rules that lead to positive outcomes.

The two-level approach to consequentialism is most often associated with R. M. Hare and Peter Singer.

Motive consequentialism

Another consequentialist version is motive consequentialism, which looks at whether the state of affairs that results from the motive to choose an action is better or at least as good as each of the alternative state of affairs that would have resulted from alternative actions. This version gives relevance to the motive of an act and links it to its consequences. An act can therefore not be wrong if the decision to act was based on a right motive. A possible inference is, that one can not be blamed for mistaken judgments if the motivation was to do good.

Negative consequentialism

Most consequentialist theories focus on promoting some sort of good consequences. However, negative utilitarianism lays out a consequentialist theory that focuses solely on minimizing bad consequences.

One major difference between these two approaches is the agent's responsibility. Positive consequentialism demands that we bring about good states of affairs, whereas negative consequentialism requires that we avoid bad ones. Stronger versions of negative consequentialism will require active intervention to prevent bad and ameliorate existing harm. In weaker versions, simple forbearance from acts tending to harm others is sufficient. An example of this is the slippery-slope argument, which encourages others to avoid a specified act on the grounds that it may ultimately lead to undesirable consequences.

Often "negative" consequentialist theories assert that reducing suffering is more important than increasing pleasure. Karl Popper, for example, claimed that "from the moral point of view, pain cannot be outweighed by pleasure." (While Popper is not a consequentialist per se, this is taken as a classic statement of negative utilitarianism.) When considering a theory of justice, negative consequentialists may use a statewide or global-reaching principle: the reduction of suffering (for the disadvantaged) is more valuable than increased pleasure (for the affluent or luxurious).

Acts and omissions

Since pure consequentialism holds that an action is to be judged solely by its result, most consequentialist theories hold that a deliberate action is no different from a deliberate decision not to act. This contrasts with the "acts and omissions doctrine", which is upheld by some medical ethicists and some religions: it asserts there is a significant moral distinction between acts and deliberate non-actions which lead to the same outcome. This contrast is brought out in issues such as voluntary euthanasia.

Actualism and possibilism

The normative status of an action depends on its consequences according to consequentialism. The consequences of the actions of an agent may include other actions by this agent. Actualism and possibilism disagree on how later possible actions impact the normative status of the current action by the same agent. Actualists assert that it is only relevant what the agent would actually do later for assessing the value of an alternative. Possibilists, on the other hand, hold that we should also take into account what the agent could do, even if she wouldn't do it.

For example, assume that Gifre has the choice between two alternatives, eating a cookie or not eating anything. Having eaten the first cookie, Gifre could stop eating cookies, which is the best alternative. But after having tasted one cookie, Gifre would freely decide to continue eating cookies until the whole bag is finished, which would result in a terrible stomach ache and would be the worst alternative. Not eating any cookies at all, on the other hand, would be the second-best alternative. Now the question is: should Gifre eat the first cookie or not? Actualists are only concerned with the actual consequences. According to them, Gifre should not eat any cookies at all since it is better than the alternative leading to a stomach ache. Possibilists, however, contend that the best possible course of action involves eating the first cookie and this is therefore what Gifre should do.

One counterintuitive consequence of actualism is that agents can avoid moral obligations simply by having an imperfect moral character. For example, a lazy person might justify rejecting a request to help a friend by arguing that, due to her lazy character, she wouldn't have done the work anyway, even if she had accepted the request. By rejecting the offer right away, she managed at least not to waste anyone's time. Actualists might even consider her behavior praiseworthy since she did what, according to actualism, she ought to have done. This seems to be a very easy way to "get off the hook" that is avoided by possibilism. But possibilism has to face the objection that in some cases it sanctions and even recommends what actually leads to the worst outcome.

Douglas W. Portmore has suggested that these and other problems of actualism and possibilism can be avoided by constraining what counts as a genuine alternative for the agent. On his view, it is a requirement that the agent has rational control over the event in question. For example, eating only one cookie and stopping afterward only is an option for Gifre if she has the rational capacity to repress her temptation to continue eating. If the temptation is irrepressible then this course of action is not considered to be an option and is therefore not relevant when assessing what the best alternative is. Portmore suggests that, given this adjustment, we should prefer a view very closely associated with possibilism called maximalism.

Issues

Action guidance

One important characteristic of many normative moral theories such as consequentialism is the ability to produce practical moral judgements. At the very least, any moral theory needs to define the standpoint from which the goodness of the consequences are to be determined. What is primarily at stake here is the responsibility of the agent.

The ideal observer

One common tactic among consequentialists, particularly those committed to an altruistic (selfless) account of consequentialism, is to employ an ideal, neutral observer from which moral judgements can be made. John Rawls, a critic of utilitarianism, argues that utilitarianism, in common with other forms of consequentialism, relies on the perspective of such an ideal observer. The particular characteristics of this ideal observer can vary from an omniscient observer, who would grasp all the consequences of any action, to an ideally informed observer, who knows as much as could reasonably be expected, but not necessarily all the circumstances or all the possible consequences. Consequentialist theories that adopt this paradigm hold that right action is the action that will bring about the best consequences from this ideal observer's perspective.

The real observer

In practice, it is very difficult, and at times arguably impossible, to adopt the point of view of an ideal observer. Individual moral agents do not know everything about their particular situations, and thus do not know all the possible consequences of their potential actions. For this reason, some theorists have argued that consequentialist theories can only require agents to choose the best action in line with what they know about the situation. However, if this approach is naïvely adopted, then moral agents who, for example, recklessly fail to reflect on their situation, and act in a way that brings about terrible results, could be said to be acting in a morally justifiable way. Acting in a situation without first informing oneself of the circumstances of the situation can lead to even the most well-intended actions yielding miserable consequences. As a result, it could be argued that there is a moral imperative for an agent to inform himself as much as possible about a situation before judging the appropriate course of action. This imperative, of course, is derived from consequential thinking: a better-informed agent is able to bring about better consequences.

Consequences for whom

Moral action always has consequences for certain people or things. Varieties of consequentialism can be differentiated by the beneficiary of the good consequences. That is, one might ask "Consequences for whom?"

Agent-focused or agent-neutral

A fundamental distinction can be drawn between theories which require that agents act for ends perhaps disconnected from their own interests and drives, and theories which permit that agents act for ends in which they have some personal interest or motivation. These are called "agent-neutral" and "agent-focused" theories respectively.

Agent-neutral consequentialism ignores the specific value a state of affairs has for any particular agent. Thus, in an agent-neutral theory, an actor's personal goals do not count any more than anyone else's goals in evaluating what action the actor should take. Agent-focused consequentialism, on the other hand, focuses on the particular needs of the moral agent. Thus, in an agent-focused account, such as one that Peter Railton outlines, the agent might be concerned with the general welfare, but the agent is more concerned with the immediate welfare of herself and her friends and family.

These two approaches could be reconciled by acknowledging the tension between an agent's interests as an individual and as a member of various groups, and seeking to somehow optimize among all of these interests. For example, it may be meaningful to speak of an action as being good for someone as an individual, but bad for them as a citizen of their town.

Human-centered?

Many consequentialist theories may seem primarily concerned with human beings and their relationships with other human beings. However, some philosophers argue that we should not limit our ethical consideration to the interests of human beings alone. Jeremy Bentham, who is regarded as the founder of utilitarianism, argues that animals can experience pleasure and pain, thus demanding that 'non-human animals' should be a serious object of moral concern.

More recently, Peter Singer has argued that it is unreasonable that we do not give equal consideration to the interests of animals as to those of human beings when we choose the way we are to treat them. Such equal consideration does not necessarily imply identical treatment of humans and non-humans, any more than it necessarily implies identical treatment of all humans.

Value of consequences

One way to divide various consequentialisms is by the types of consequences that are taken to matter most, that is, which consequences count as good states of affairs. According to utilitarianism, a good action is one that results in an increase in pleasure, and the best action is one that results in the most pleasure for the greatest number. Closely related is eudaimonic consequentialism, according to which a full, flourishing life, which may or may not be the same as enjoying a great deal of pleasure, is the ultimate aim. Similarly, one might adopt an aesthetic consequentialism, in which the ultimate aim is to produce beauty. However, one might fix on non-psychological goods as the relevant effect. Thus, one might pursue an increase in material equality or political liberty instead of something like the more ephemeral "pleasure". Other theories adopt a package of several goods, all to be promoted equally. As the consequentialist approach contains an inherent assumption that the outcomes of a moral decision can be quantified in terms of "goodness" or "badness," or at least put in order of increasing preference, it is an especially suited moral theory for a probabilistic and decision theoretical approach.

Virtue ethics

Consequentialism can also be contrasted with aretaic moral theories such as virtue ethics. Whereas consequentialist theories posit that consequences of action should be the primary focus of our thinking about ethics, virtue ethics insists that it is the character rather than the consequences of actions that should be the focal point. Some virtue ethicists hold that consequentialist theories totally disregard the development and importance of moral character. For example, Philippa Foot argues that consequences in themselves have no ethical content, unless it has been provided by a virtue such as benevolence.

However, consequentialism and virtue ethics need not be entirely antagonistic. Iain King has developed an approach that reconciles the two schools. Other consequentialists consider effects on the character of people involved in an action when assessing consequence. Similarly, a consequentialist theory may aim at the maximization of a particular virtue or set of virtues. Finally, following Foot's lead, one might adopt a sort of consequentialism that argues that virtuous activity ultimately produces the best consequences.

Max Weber

Ultimate end

The ultimate end is a concept in the moral philosophy of Max Weber, in which individuals act in a faithful, rather than rational, manner.

We must be clear about the fact that all ethically oriented conduct may be guided by one of two fundamentally differing and irreconcilably opposed maxims: conduct can be oriented to an ethic of ultimate ends or to an ethic of responsibility. [...] There is an abysmal contrast between conduct that follows the maxim of an ethic of ultimate ends — that is in religious terms, "the Christian does rightly and leaves the results with the Lord" — and conduct that follows the maxim of an ethic of responsibility, in which case one has to give an account of the foreseeable results of one's action.

— Max Weber, Politics as a Vocation, 1918

Teleological ethics

Teleological ethics (Greek: telos, 'end, purpose' + logos, 'science') is a broader class of views in moral philosophy which consequentialism falls under. In general, proponents of teleological ethics argue that the moral value of any act consists in its tendency to produce things of intrinsic value, meaning that an act is right if and only if it, or the rule under which it falls, produces, will probably produce, or is intended to produce, a greater balance of good over evil than any alternative act. This concept is exemplified by the famous aphorism, "the end justifies the means," variously attributed to Machiavelli or Ovid i.e. if a goal is morally important enough, any method of achieving it is acceptable.

Teleological theories differ among themselves on the nature of the particular end that actions ought to promote. The two major families of views in teleological ethics are virtue ethics and consequentialism. Teleological ethical theories are often discussed in opposition to deontological ethical theories, which hold that acts themselves are inherently good or bad, rather than good or bad because of extrinsic factors (such as the act's consequences or the moral character of the person who acts).

Etymology

The term consequentialism was coined by G. E. M. Anscombe in her essay "Modern Moral Philosophy" in 1958, to describe what she saw as the central error of certain moral theories, such as those propounded by Mill and Sidgwick.

The phrase and concept of "the end justifies the means" are at least as old as the first century BC. Ovid wrote in his Heroides that Exitus acta probat ("The result justifies the deed").

Criticisms

G. E. M. Anscombe objects to the consequentialism of Sidgwick on the grounds that the moral worth of an action is premised on the predictive capabilities of the individual, relieving them of the responsibility for the "badness" of an act should they "make out a case for not having foreseen" negative consequences.

The future amplification of the effects of small decisions is an important factor that makes it more difficult to predict the ethical value of consequences, even though most would agree that only predictable consequences are charged with a moral responsibility.

Bernard Williams has argued that consequentialism is alienating because it requires moral agents to put too much distance between themselves and their own projects and commitments. Williams argues that consequentialism requires moral agents to take a strictly impersonal view of all actions, since it is only the consequences, and not who produces them, that are said to matter. Williams argues that this demands too much of moral agents—since (he claims) consequentialism demands that they be willing to sacrifice any and all personal projects and commitments in any given circumstance in order to pursue the most beneficent course of action possible. He argues further that consequentialism fails to make sense of intuitions that it can matter whether or not someone is personally the author of a particular consequence. For example, that participating in a crime can matter, even if the crime would have been committed anyway, or would even have been worse, without the agent's participation.

Some consequentialists—most notably Peter Railton—have attempted to develop a form of consequentialism that acknowledges and avoids the objections raised by Williams. Railton argues that Williams's criticisms can be avoided by adopting a form of consequentialism in which moral decisions are to be determined by the sort of life that they express. On his account, the agent should choose the sort of life that will, on the whole, produce the best overall effects.

Machiavellianism (psychology)

From Wikipedia, the free encyclopedia
 
Machiavellianism
The Dark Triad.png
Machiavellianism is one of the traits in the dark triad model, along with psychopathy and narcissism.
SpecialtyPersonality psychology
CausesGenetic and environmental

In the field of personality psychology, Machiavellianism is a personality trait centered on manipulativeness, callousness, and indifference to morality. Though unrelated to the historical figure or his works, the trait is named after the political philosophy of Niccolò Machiavelli, as psychologists Richard Christie and Florence Geis used edited and truncated statements inspired by his works to study variations in human behaviors. Their Mach IV test, a 20-question, Likert-scale personality survey, became the standard self-assessment tool and scale of the Machiavellianism construct. Those who score high on the scale (High Machs) are more likely to have a high level of deceitfulness and an unempathetic temperament.

It is one of the dark triad traits, along with narcissism and psychopathy.

Origin of the construct

In the 1960s, Richard Christie and Florence L. Geis wanted to analyze those who manipulated others, and developed a test using a selection of statements, including a few truncated and edited sentences from Machiavelli's works as test items, naming the construct "Machiavellianism" after Machiavelli. They wanted to assess whether or not those who were in agreement with the statements would behave differently than others who disagreed, specifically in regards to manipulative actions. Their Mach IV test, a 20-question, Likert-scale personality survey, became the standard self-assessment tool of the Machiavellianism construct. Using their scale, Christie and Geis conducted multiple experimental tests that showed that the interpersonal strategies and behavior of "high Machs" and "low Machs" differ. People scoring high on the scale (high Machs) tend to endorse manipulative statements, and behave accordingly, contrary to those who score lowly (low Machs). Their basic results have been widely replicated. Measured on the Mach IV scale, males score, on average, slightly higher on Machiavellianism than females.

Etiology

A behavioral genetics study noted that Machiavellianism has both significantly genetic and environmental influences. There has also been extensive research on Machiavellianism in young children and adolescents, via a measure dubbed the "kiddie Mach" test.

Motivation

A 1992 review described the motivation of those high on the Machiavellianism scale as related to cold selfishness and pure instrumentality, and those high on the trait were assumed to pursue their motives (e.g. sex, achievement, sociality) in duplicitous ways. More recent research on the motivations of high Machs compared to low Machs found that they gave high priority to money, power, and competition and relatively low priority to community building, self-love, and family commitment. High Machs admitted to focusing on unmitigated achievement and winning at any cost.

Opportunism

In general, people high in Machiavellianism will attempt to achieve their goals by whatever means necessary. This includes things such as bending and breaking rules, cheating, and stealing. People high in Machiavellianism are able to easily switch between working with others and using others to achieve their goals. People high in Machiavellianism do not have the same level of emotions as others and as such are more willing to do things others see as terrible or immoral. In the pursuit of their goals, people high in Machiavellianism will even go so far as to hurt and manipulate others if they think it would be beneficial.

Abilities

Due to their skill at interpersonal manipulation, there has often been an assumption that high Machs possess superior intelligence, or ability to understand other people in social situations. However, some research has established that Machiavellianism is unrelated to IQ. Recently, new research gives support to a contrary viewpoint.

Furthermore, studies on emotional intelligence have found that high Machiavellianism is usually associated with low emotional intelligence as assessed by both performance and questionnaire measures. Both emotional empathy and emotion recognition have been shown to have negative correlations with Machiavellianism. Additionally, research has shown that Machiavellianism is unrelated to a more advanced theory of mind, that is, the ability to anticipate what others are thinking in social situations. If high Machs actually are skilled at manipulating others, this appears to be unrelated to any special cognitive abilities as such, and may simply be due to a greater willingness to engage in manipulation.

Relations with other personality traits

Narcissism and psychopathy

Machiavellianism is one of the three personality traits referred to as the dark triad, along with narcissism and psychopathy. Some psychologists consider Machiavellianism to be essentially a subclinical form of psychopathy, as they both share manipulative tendencies and cold callousness as their primary attributes. More recent research suggests that while Machiavellianism and psychopathy overlap heavily, they are distinct personality constructs. Psychopathy differs from Machiavellianism only in impulsivity, a lack of long term planning and self control, as psychopaths tend to be reckless.

Big Five

Machiavellianism has been found to be negatively correlated with agreeableness (r = −0.47) and conscientiousness (r = −0.34), two dimensions of the "big five" personality model (NEO-PI-R). However, Machiavellianism correlates more highly with the honesty-humility dimension of the six-factor HEXACO model than with any of the big five dimensions. Machiavellianism has also been located within the interpersonal circumplex, which consists of the two independent dimensions of agency and communion. Agency refers to the motivation to succeed and to individuate the self, whereas communion refers to the motivation to merge with others and to support group interests. Machiavellianism lies in the quadrant of the circumplex defined by high agency and low communion. Machiavellianism has been found to lie diagonally opposite from a circumplex construct called self-construal, a tendency to prefer communion over agency. This suggests that people high in Machiavellianism do not simply wish to achieve, they wish to do so at the expense of (or at least without regard to) others.

Game theory

In 2002, the Machiavellianism scale of Christie and Geis was applied by behavioral game theorists Anna Gunnthorsdottir, Kevin McCabe and Vernon L. Smith in their search for explanations for the spread of observed behavior in experimental games, in particular individual choices which do not correspond to assumptions of material self-interest captured by the standard Nash equilibrium prediction. It was found that in a trust game, those with high Mach-IV scores tended to follow homo economicus' equilibrium strategies while those with low Mach-IV scores tended to deviate from the equilibrium, and instead made choices that reflected widely accepted moral standards and social preferences.

Dimensionality

Although there have been myriad proposed factor structures, two dimensions emerge most consistently within factor-analytic research – differentiating Machiavellian views from behaviors. Although the Mach IV scale is unable to reliably capture the two dimensions, a 10-item subset of the scale known as the "two-dimensional Mach IV" (TDM-V), reproduces the views and tactics dimensions across countries, genders, sample types, and scale category length. The "views" dimension appears to capture the neurotic, narcissistic, pessimistic, and distrustful aspects of Machiavellianism, while the "tactics" component captures the more unconscientious, self-serving, and deceitful behavioral aspects.

Hot and cold empathy

There are two distinct types of empathy which people use to relate to each other which are referred to as hot and cold empathy. Cold empathy refers to the understanding of how others might react to one's actions or a certain event. Hot empathy refers to the emotional reaction others might have to an event. People high in machiavellianism tend to have a better understanding of cold empathy and do not feel hot empathy which explains why they are so cold and uncaring. This way of acting is referred to as a cold to hot empathy gap where someone with cold empathy does not realize the full effect of their actions on others.

Alexithymia

Alexithymia is considered a key trait associated with Machiavellianism. It is the lack of awareness of emotion, including one's own emotion and the emotion of others. Those with alexithymia, alexithymics, are unable to recognize emotion nor describe them. This can lead to problems figuring out one's own feelings as well as relating and connecting to how others feel. Alexithymia can manifest in various degrees, depending on the individual and their environment. It may be product of a limited understanding of an emotion after a shallow experience of said emotion. Alexithymia is suspected to be the reason why Machiavellians focus so much mental energy towards manipulating people and situations. They do not recognize the feeling of guilt and empathy so there is little to no consequence.

In the workplace

Machiavellianism is also studied by organizational psychologists, especially those who study manipulative behaviors in workplace settings. Workplace behaviors associated with this concept include flattery, deceit, coercion, workplace cheating behaviors, and abusive supervision. Manipulative behaviors in the workplace encompass cheating behaviors because they are ultimately done to advance personal interests through lying, scamming, and being deceptive.

Machiavellianism can also have a moderating effect on job pursuit intentions. This is because job seekers have access to so many internet resources that can provide information and background on potential employers. This wide availability of information about an organization's political climate can have a huge effect on the recruiting process. Machiavellianism can be a moderator in this relationship because "this trait reflects the extent to which an individual would 'fit' into a highly political work environment"

Narcissistic personality disorder

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Narcissistic_personality_disorder
Narcissistic personality disorder
SpecialtyPsychiatry
SymptomsExaggerated feelings of self-importance, excessive craving for admiration, reduced levels of empathy
Usual onsetEarly adulthood
DurationLong term
CausesUnknown
Differential diagnosisBipolar disorder, substance abuse, borderline personality disorder, histrionic personality disorder
TreatmentPsychotherapy, pharmaceuticals
Frequency<1% of population

Narcissistic personality disorder (NPD) is a mental disorder characterized by a life-long pattern of exaggerated feelings of self-importance, an excessive craving for admiration, and a diminished ability to empathize with other's feelings. Narcissistic personality disorder is one of the eleven sub-types of the broader category known as personality disorders.

Personality disorders are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture. These patterns develop early, are inflexible, and are associated with significant distress or disability.

Criteria for diagnosing personality disorders are listed in the fifth chapter of the International Classification of Diseases (ICD) and in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM).

Signs and symptoms

Narcissistic personality disorder is a mental disorder characterized by a life-long pattern of exaggerated feelings of self-importance, an excessive craving for admiration, and a diminished ability to empathize with other's feelings. These personality traits are often overcompensation for a fragile ego, an intolerance of criticism, and a weak sense of self.

Narcissistic personality disorder differs from self-confidence which is associated with a strong sense of self.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-5, 2013) describes NPD as possessing at least five of the following nine criteria.

  • A grandiose sense of self-importance
  • Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  • Believing that they are "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
  • Requiring excessive admiration
  • A sense of entitlement (unreasonable expectations of especially favorable treatment or automatic compliance with their expectations)
  • Being interpersonally exploitative (taking advantage of others to achieve their own ends)
  • Lacking empathy (unwilling to recognize or identify with the feelings and needs of others)
  • Often being envious of others or believing that others are envious of them
  • Showing arrogant, haughty behaviors or attitudes

Narcissistic personality disorder usually develops either in youth or in early adulthood. It is common for children and youths to display personality traits that resemble NPD, but such occurrences are usually transient, and register below the clinical criteria for a formal diagnosis of NPD. True symptoms of NPD are pervasive, apparent in varied social situations, and are rigidly consistent over time. Severe symptoms of NPD can significantly impair the person's mental capabilities to develop meaningful human relationships, such as friendship, kinship, and marriage. Generally, the symptoms of NPD also impair the person's psychological abilities to function socially, either at work or at school, or within important societal settings. The DSM-5 indicates that, in order to qualify as symptomatic of NPD, the person's manifested personality traits must substantially differ from social norms.

Associated features

People with NPD exaggerate their skills, accomplishments, and their degree of intimacy with people they consider high-status. Such a sense of personal superiority may cause them to monopolize conversations, or to become impatient and disdainful when other persons talk about themselves. This attitude connects to an overall worse functioning in areas of life like work and intimate romantic relationships.

Narcissistic injury and narcissistic scar are terms used by Sigmund Freud in the 1920s. Narcissistic wound and narcissistic blow are other, almost interchangeable, terms. When wounded in the ego, either by a real or a perceived criticism, the narcissist's displays of anger can be disproportionate to the nature of the criticism suffered; but typically, the actions and responses of the NPD person are deliberate and calculated. Despite occasional flare-ups of personal insecurity, the inflated self-concept of the NPD person is primarily stable.

To the extent that people are pathologically narcissistic, the person with NPD can be a self-absorbed control freak who passes blame by psychological projection and is intolerant of contradictory views and opinions; is apathetic towards the emotional, mental, and psychological needs of other people; and is indifferent to the negative effects of their behaviors, whilst insisting that people should see them as an ideal person. To protect their fragile self-concept, narcissists use psychosocial strategies, such as the tendency to devalue and derogate and to insult and blame other people, usually with anger and hostility towards people's responses to the narcissist's anti-social conduct. Narcissistic personalities are more likely to respond with anger or aggressiveness when presented with rejection. Because they are sensitive to perceived criticism or defeat, people with NPD are prone to feelings of shame, humiliation, and worthlessness over minor incidents of daily life and imagined, personal slights, and usually mask such feelings from people, either by way of feigned humility, or by responding with outbursts of rage and defiance, or by seeking revenge. The merging of the inflated self-concept and the actual self is evident in the grandiosity component of narcissistic personality disorder; also inherent to that psychological process are the defence mechanisms of idealization and devaluation and of denial.

The DSM-5 indicates that: "Many highly successful individuals display personality traits that might be considered narcissistic. Only when these traits are inflexible, maladaptive, and persisting, and cause significant functional impairment or subjective distress, do they constitute narcissistic personality disorder." Given the high-function sociability associated with narcissism, some people with NPD might not view such a diagnosis as a functional impairment to their lives. Although overconfidence tends to make people with NPD very ambitious, such a mindset does not necessarily lead to professional high achievement and success, because they refuse to take risks, in order to avoid failure or the appearance of failure. Moreover, the psychological inability to tolerate disagreement, contradiction, and criticism, make it difficult for persons with NPD to work cooperatively or to maintain long-term, professional relationships with superiors and colleagues.

Some narcissists may have a limited or minimal capability to experience emotions.

Narcissistic supply

Narcissistic supply is a concept introduced into psychoanalytic theory by Otto Fenichel in 1938, to describe a type of admiration, interpersonal support or sustenance drawn by an individual from his or her environment and essential to their self-esteem. The term is typically used in a negative sense, describing a pathological or excessive need for attention or admiration in codependents and the orally fixated, that does not take into account the feelings, opinions or preferences of other people.

Narcissistic rage

Narcissistic rage is a reaction to a perceived threat to a narcissist's self-esteem or self-worth. The term narcissistic rage was coined by Heinz Kohut in 1972. Narcissistic rage occurs on a continuum from aloofness, to expressions of mild irritation or annoyance, to serious outbursts, including violent attacks.

Narcissistic rage reactions are not limited to personality disorders. They may also be seen in catatonic, paranoid delusion, and depressive episodes. It has been suggested that narcissists have two layers of rage. The first layer of rage can be thought of as a constant anger towards someone else, with the second layer being a self-aimed anger.

Type theories

The DSM-5 indicates narcissistic personality disorder as a homogeneous syndrome. Since its inclusion in the DSM, NPD has been primarily conceptualized by overt and grandiose phenomena. This characterization has been criticized as not fully capturing all of the clinical phenomena and there has been much theoretical and empirical work suggesting that NPD is not a homogenous disorder but rather that subtypes exist. There is not consensus on how many subtypes exist, but there is broad acceptance that there are at least two.

None of the subtypes of NPD are currently recognized in the Diagnostic and Statistical Manual of Mental Disorders or in the International Statistical Classification of Diseases and Related Health Problems.

Grandiose and vulnerable narcissism theory

Grandiose narcissism is characterized by personality traits of grandiosity, arrogance, and boldness. The research indicates that people with grandiose narcissism express behavior "through interpersonally exploitative acts, lack of empathy, intense envy, aggression, and exhibitionism."

Vulnerable narcissism is characterized by the personality traits of defensiveness and hypersensitivity.

Numerous studies (Miller & Campbell, 2008; Russ, Shedler, Bradley, & Westen, 2008; Wink, 1991) have demonstrated that narcissism has two or more variants: grandiose narcissism and vulnerable narcissism. The grandiose variant, which is usually measured using the NPI, is strongly linked to the DSM-IV conceptualization and is the variant associated with NPD, a Cluster B personality disorder which reflects traits related to self-importance, entitlement, aggression, and dominance. Vulnerable narcissism reflects a defensive and fragile grandiosity, which functions mainly as a cover for feelings of inadequacy. Vulnerable narcissism is characterized by hypersensitivity, defensiveness, and withdrawal and is strongly associated with borderline personality disorder (BPD), which is characterized by the fear of abandonment, interpersonal and affective instability, impulsivity, chronic feelings of emptiness, suicidal ideation, and self-mutilation. The Maladaptive Covert Narcissism Scale (MCNS) is often used to measure vulnerable narcissism where the criteria for assessing grandiose narcissism risk to lead to imprecise results. Pathological narcissism is when both grandiose and vulnerable narcissism is concurrent, which is linked to poor self-esteem, lack of empathy, feelings of shame, interpersonal distress, aggression, and significant impairments in personality functioning across both clinical and non-clinical samples.

Pathological narcissism, as measured by the Pathological Narcissism Inventory (PNI), is embedded within the personality disorders organized at the borderline level, which include antisocial, borderline, narcissistic personality disorders. PNI scales exhibited significant associations with parasuicidal behavior, suicide attempts, homicidal ideation, and several aspects of psychotherapy utilization. Despite the phenomenological and empirical distinction between vulnerable and grandiose narcissism, there is experimental evidence from studies that have employed direct or indirect ego-threat to suggest that grandiose narcissists have also a fragile, vulnerable core.

Oblivious and hypervigilant narcissism theory

In an inventory of the types of NPD, the psychiatrist Glen Gabbard described the "oblivious" subtype of narcissist as being a grandiose, arrogant, and thick-skinned person; and described the "narcissistic vulnerability" of the subtype of person who consciously exhibits the personality traits of helplessness and emotional emptiness, and of low self-esteem and shame, which usually are expressed as socially avoidant behavior in situations where the narcissist's self-presentation is impossible; therefore, they withdraw from situations wherein the needed or expected social approval is not given.

Gabbard also described the "hypervigilant" subtype of narcissist whose feelings are easily hurt, has an oversensitive temperament, and ashamed; and described the "high-functioning" subtype of narcissist as a person less functionally impaired in the areas of life where narcissists with a severe expression of NPD usually have difficulties in functioning as a normally-socialized person.

Malignant, fragile, and high functioning narcissism theory

Russ, Shedler, Bradley, and Westen characterized three subtypes among the NPD patients they studied: (a) grandiose/malignant; (b) fragile; and (c) high functioning/exhibitionistic. The researchers concluded that "Grandiose narcissists were characterized as angry, interpersonally manipulative, and lacking empathy and remorse; their grandiosity was seen as neither defensive nor compensatory. Fragile narcissists demonstrated grandiosity under threat (defensive grandiosity) and experienced feelings of inadequacy and anxiety, indicating that they vacillate between superiority and inferiority. High functioning narcissists were grandiose, competitive, attention-seeking, and sexually provocative; they tended to show adaptive functioning and utilize their narcissistic traits to succeed."

Millon's variations

In the study Disorders of Personality: DSM-IV-TM and Beyond (1996), Theodore Millon suggested five subtypes of narcissist; however, there are few, pure subtypes of narcissist.

  • Unprincipled narcissist: Deficient conscience; unscrupulous, amoral, disloyal, fraudulent, deceptive, arrogant, exploitive; a con artist and charlatan; dominating, contemptuous, vindictive.
  • Amorous narcissist: Sexually seductive, enticing, beguiling, tantalizing; glib and clever; disinclined to real intimacy; indulges hedonistic desires; bewitches and inveigles others; pathological lying and swindling. Tends to have many affairs, often with exotic partners.
  • Compensatory narcissist: Seeks to counteract or cancel out deep feelings of inferiority and lack of self-esteem; offsets deficits by creating illusions of being superior, exceptional, admirable, noteworthy; self-worth results from self-enhancement.
  • Elitist narcissist: Feels privileged and empowered by virtue of special childhood status and pseudo-achievements; entitled façade bears little relation to reality; seeks favored and good life; is upwardly mobile; cultivates special status and advantages by association.
  • Normal narcissist: Least severe and most interpersonally concerned and empathetic, still entitled and deficient in reciprocity; bold in environments, self-confident, competitive, seeks high targets, feels unique; talent in leadership positions; expecting recognition from others.

In 1996, Theodore Millon identified four variations of narcissist. Any individual narcissist may exhibit none or one of the variations.

Masterson's subtypes (exhibitionist and closet)

In 1993, James F. Masterson proposed two categories for pathological narcissism, exhibitionist and closet. Both fail to adequately develop an age- and phase- appropriate self because of defects in the quality of psychological nurturing provided, usually by the mother. The exhibitionist narcissist is the one described in DSM-IV and differs from the closet narcissist in several important ways. The closet narcissist is more likely to be described as having a deflated, inadequate self-perception and greater awareness of emptiness within. The exhibitionist narcissist would be described as having an inflated, grandiose self-perception with little or no conscious awareness of the emptiness within. Such a person would assume that this condition was normal and that others were just like him. The closet narcissist seeks constant approval from others and appears similar to the borderline in the need to please others. The exhibitionist narcissist seeks perfect admiration all the time from others.

Malignant narcissism

Malignant narcissism, a term first coined in a book by Erich Fromm in 1964, is a syndrome consisting of a crossbreed of the narcissistic personality disorder, the antisocial personality disorder, as well as paranoid traits. The malignant narcissist differs from one suffering from a narcissistic personality disorder in that the malignant narcissist derives higher levels of psychological gratification from accomplishments over time (thus worsening the disorder). Because the malignant narcissist becomes more involved in this psychological gratification, in the context of the right conditions, the narcissist is apt to develop the antisocial, the paranoid, and the schizoid personality disorders. The term malignant is added to the term narcissist to indicate that individuals with this disorder have a severe form of narcissistic disorder that is characterized also by features of paranoia, psychopathy (anti-social behaviors), aggression, and sadism according to Kernberg and colleagues.

Primordial narcissism

Psychiatrist Ernst Simmel first defined primordial narcissism in 1944. Simmel's fundamental thesis is that the most primitive stage of libidinal development is not the oral, but the gastrointestinal one. The mouth and anus are merely to be considered as the terminal parts of this organic zone. Simmel terms the psychological condition of prenatal existence "primordial narcissism." It is the vegetative stage of the pre-ego, identical with the id. At this stage, there is complete instinctual repose, manifested in unconsciousness. Satiation of the gastrointestinal zone, the representative of the instinct of self-preservation, can bring back this complete instinctual repose, which, under pathological conditions, can become the aim of the instinct. Contrary to Lasch, Bernard Stiegler argues in his book, Acting Out, that consumer capitalism is in fact destructive of what he calls primordial narcissism, without which it is not possible to extend love to others. In other words, he is referring to the natural state of an infant as a fetus and in the first few days of its life, before it has learned that other people exist besides itself, and therefore cannot possibly be aware that they are human beings with feelings, rather than having anything to do with actual narcissism.

Diagnosis

The causes of narcissistic personality disorder are unknown, but theorized to be linked to certain types of traumas. The condition of NPD is included in the cluster B personality disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM). A diagnosis of NPD is made by a healthcare professional interviewing the person in question. The condition of NPD should be differentiated from mania and substance use disorder.

The causes of narcissistic personality disorder are unknown. Researchers apply a biopsychosocial model of causation, whereby the occurrence and the expression of NPD – a pathological amplification of the traits of the narcissistic personality – are consequent to a combination of nature and nurture, of environmental and social, genetic and neurobiological factors.

The occurrence of narcissistic personality disorder presents a high rate of comorbidity with other mental disorders. People with NPD are prone to bouts of psychological depression, often to the degree that meets the clinical criteria for a co-occurring depressive disorder. Moreover, the occurrence of NPD is further associated with the occurrence of bipolar disorder and substance use disorders, especially cocaine use disorder. In that vein, NPD also might be comorbid with the occurrence of other mental disorders, such as histrionic personality disorder, borderline personality disorder, antisocial personality disorder, or paranoid personality disorder.

Genetic

Narcissistic personality disorder is an inheritable psychological condition; research evidence indicates that a person is more likely to develop NPD if said personality disorder occurs in the medical history of his or her family. The results reported in A Twin Study of Personality Disorders (2000) indicate that the rate of occurrence of personality disorders in twins determined that there is a moderate-to-high likelihood of the heritability of NPD; and the research of The Genetic Epidemiology of Personality Disorders (2010) indicates that specific genes and genetic interactions (epistasis) contribute to the formation of NPD, and to the development of a narcissistic personality, yet how genetics influences the developmental and the physiologic processes underlying NPD remains undetermined.

Twin studies

Livesley et al. concluded, in agreement with other studies, that narcissism, as measured by a standardized test, was a common inherited trait. Additionally, in similar agreement with those other studies, it was found that there exists a continuum between normal and disordered personality. The study subjects were 175 volunteer twin pairs (ninety identical, eighty-five fraternal) drawn from the general population. Each twin completed a questionnaire that assessed eighteen dimensions of personality disorder. The authors estimated the heritability of each dimension of personality by standard methods, thus providing estimates of the relative contributions of genetic and environmental causation. Of the eighteen personality dimensions, narcissism was found to have the highest heritability (0.64), indicating that the concordance of this trait in the identical twins was significantly influenced by genetics. Of the other dimensions of personality, only four were found to have heritability coefficients of greater than 0.5: callousness, identity problems, oppositionality, and social avoidance.

Environment

Environmental and social factors also exert significant influence upon the onset of NPD in a person. In some people, pathological narcissism may develop from an impaired emotional attachment to the primary caregivers, usually the parents. That lack of psychological and emotional attachment to a parental figure can result in the child's perception of themselves as unimportant and unconnected to other people, usually, family, community and society. Typically, the child comes to believe that they have a personality defect that makes them an unvalued and unwanted person; in that vein, either overindulgent and permissive parenting or insensitive and over-controlling parenting are contributing factors towards the development of NPD in a child.

In Gabbard's Treatments of Psychiatric Disorders (2014), the following factors are identified as promoting the development of narcissistic personality disorder:

  • An oversensitive temperament (individual differences of behavior) at birth
  • Excessive admiration that is never balanced with realistic criticism
  • Excessive praise for good behaviors, or excessive criticism for bad behaviors in childhood
  • Overindulgence and overvaluation by family or peers
  • Being praised by adults for perceived exceptional physical appearance or abilities
  • Trauma caused by psychological abuse, physical abuse or sexual abuse in childhood
  • Unpredictable or unreliable parental caregiving
  • Learning the behaviors of psychological manipulation from parents or peers

Moreover, the research reported in "Modernity and Narcissistic Personality Disorders" (2014) indicates that cultural elements also influence the prevalence of NPD, because narcissistic personality traits more commonly occur in modern societies than in traditionalist conservative societies.

Pathophysiology

Studies of the occurrence of narcissistic personality disorder, such as Gray Matter Abnormalities in Patients with Narcissistic Personality Disorder (2013) and Narcissists' Lack of Empathy Tied to Less Gray Matter (2016) identified structural abnormalities in the brains of people afflicted with NPD, specifically, a lesser volume of gray matter in the left, anterior insular cortex. The results of the study Brain Structure in Narcissistic Personality Disorder: A VBM and DTI Pilot Study (2015) associated the condition of NPD with a reduced volume of gray matter in the prefrontal cortex. The regions of the brain identified and studied – the insular cortex and the prefrontal cortex – are associated with the human emotions of empathy and compassion, and with the mental functions of cognition and emotional regulation. The neurologic findings of the studies suggest that NPD may be related to a compromised (damaged) capacity for emotional empathy and emotional regulation.

Narcissistic Personality Inventory

The Narcissistic Personality Inventory (NPI) is the most widely used measure of narcissism in social psychological research. Although several versions of the NPI have been proposed in the literature, a forty-item forced-choice version (Raskin & Terry, 1988) is the one most commonly employed in current research. Another shorter version, a sixteen-item version NPI-16 (Ames, Rose & Anderson, 2013) is also present. The NPI is based on the DSM-III clinical criteria for narcissistic personality disorder (NPD), although it was designed to measure these features in the general population. Thus, the NPI is often said to measure "normal" or "subclinical" (borderline) narcissism (i.e., in people who score very high on the NPI do not necessarily meet criteria for diagnosis with NPD).

Millon Clinical Multiaxial Inventory

The Millon Clinical Multiaxial Inventory (MCMI) is a widely used diagnostic test developed by Theodore Millon. The MCMI includes a scale for narcissism. The NPI and MCMI have been found to be well correlated, r(146) = 0.55, p < 0.001. Whereas the MCMI measures narcissistic personality disorder (NPD), the NPI measures narcissism as it occurs in the general population. In other words, the NPI measures "normal" narcissism; i.e., most people who score very high on the NPI do not have NPD. Indeed, the NPI does not capture any sort of narcissism taxon as would be expected if it measured NPD.

A 2020 study found that females scored significantly higher on vulnerable narcissism than males, but no gender differences were found for grandiose narcissism.

DSM-5

Within the DSM-5, NPD is a cluster B personality disorder. Individuals with cluster B personality disorders often appear dramatic, emotional, or erratic.

NPD was revised in the DSM-5. The general move towards a dimensional (personality trait-based) view of the personality disorders has been maintained.

ICD-10

The International Statistical Classification of Diseases and Related Health Problems, 10th Edition (ICD-10), of the World Health Organization (WHO), lists narcissistic personality disorder (NPD) under the category of "Other specific personality disorders". The ICD-10 requires that any personality-disorder diagnosis also meet and satisfy the General diagnostic criteria 2 used for determining that a person has a diagnosable personality disorder.

Management

Management of narcissistic personality disorder have not been well studied. Therapy is difficult, because people with NPD usually do not consider their own issues as symptoms, despite mental distress. Additionally, people with narcissistic personality disorders have decreased life satisfaction and lower qualities of life, even when their narcissism is undiagnosed. People with NPD may have other comorbid psychiatric conditions as well, making it more difficult to identify the symptoms. About one percent of people are believed to be affected with NPD at some point in their lives. It occurs more often in men than women, and typically affects younger as opposed to older people. The narcissistic personality was first described by the psychoanalyst Robert Waelder in 1925. The term narcissistic personality disorder (NPD) was coined by Heinz Kohut in 1968.

Narcissistic personality disorder is rarely the primary reason for which people seek mental health treatment. When people with NPD enter treatment (psychologic or psychiatric), they usually are prompted by difficulties in their lives, or are seeking relief from some other disorder of their mental health, such as a major depressive disorder, a substance use disorder (drug addiction), or bipolar disorder. The reason for such an indirect path to psychotherapeutic treatment is partly because narcissists generally possess poor insight, and are unaware that their actions produced their mentally unhealthy circumstance, and so fail to recognize that their perceptions and behaviors are socially inappropriate and problematic, because of their very positive self-image (inflated self-concept).

In general, psychotherapy is the basis for treating narcissistic personality disorder. In the 1960s, Heinz Kohut and Otto Kernberg challenged the conventional wisdom of the time with clinical strategies that applied psychoanalytic therapy to NPD clients, which, they claimed, effectively treated that personality disorder. Contemporary psychotherapy treatments include transference-focused therapy; metacognitive therapy; and schema therapy, to treat the client's particular subtype of NPD. Improvements to the mental health of patients with NPD are possible with psychopharmaceutical treatment of the symptoms of the comorbid disorders; despite such drug therapy, the psychologist Elsa Ronningstam said that "alliance-building and engaging the patient's sense of agency and reflective ability are essential for [achieving] change in pathological narcissism." Psychiatric medications usually are not indicated for treating NPD, but can be used to treat the co-occurring symptoms of psychological depression, anxiety, and impulsiveness, when present in the NPD client. In the field of relationship counseling mental health therapy is most beneficial when both partners participate in the treatments.

Prognosis

The effectiveness of psychotherapeutic and pharmacological interventions in the treatment of narcissistic personality disorder have yet to be systematically and empirically investigated. Clinical practice guidelines for the disorder have not yet been created, and current treatment recommendations are largely based on theoretical psychodynamic models of NPD and the experiences of clinicians with afflicted individuals in clinical settings.

The presence of NPD in patients undergoing psychotherapy for the treatment of other mental disorders is associated with slower treatment progress and higher dropout rates.

Epidemiology

The lifetime rates of narcissistic personality disorder are estimated at 1% in the general population; and between 2% and 16% in the clinical population. A 2010 review found rates of NPD of up to 6% in community samples, and that the yearly number of new cases of NPD in men is slightly greater than in women. A 2015 review found that the rates of NPD have been relatively stable for men and women throughout the thirty-year period in which data were collected.

History

The historical use of the term narcissism, to describe a person's excessive vanity and self-centeredness predates the modern medical classification of NPD (narcissistic personality disorder). The mental condition of narcissism is named after the mythological character Narcissus, a beautiful boy, born of a nymph, who became infatuated with his own reflection in a pool of water. At first, Narcissus did not understand that the image he saw in the pool of water was a reflection of himself; when he did understand that fact, he pined for the unattainable image and died of grief, for having fallen in love with someone who did not exist outside of himself.

The term megalomania first came into usage in the late 1800s and began to be used popularly by the public in the early 1900s. A former mental disorder, megalomania has since been removed from the DSM, and forged in with narcissistic personality disorder. In popular culture, narcissistic personality disorder (NPD) is also known as megalomania.

Further conceptual developments and refinements of the mental condition of narcissism produced the term narcissistic personality structure, which was introduced by Otto Friedmann Kernberg, in 1967; and the term narcissistic personality disorder, which was proposed by Heinz Kohut, in 1968.

Early Freudianism

Regarding the adult neurotic's sense of omnipotence, Sigmund Freud said that "this belief is a frank acknowledgement of a relic of the old megalomania of infancy"; and concluded that: "we can detect an element of megalomania in most other forms of paranoic disorder. We are justified in assuming that this megalomania is essentially of an infantile nature, and that, as development proceeds, it is sacrificed to social considerations."

In The Psychology of Gambling (1957), Edmund Bergler considered megalomania to be a normal occurrence in the psychology of a child, a condition later reactivated in adult life, if the individual takes up the vice of gambling. In The Psychoanalytic Theory of Neurosis (1946), Otto Fenichel said that people who, in their later lives, respond with denial to their own narcissistic injury usually undergo a similar regression to the megalomania of childhood.

Object relations

In the second half of the 20th century, in contrast to Freud's perspective that megalomania is an obstacle to psychoanalysis, in the US and UK, Kleinian psychologists used the object relations theory to re-evaluate megalomania as a defence mechanism, a circumstance that offered the psychotherapist access to the patient for treatment. Such a Kleinian therapeutic approach built upon Heinz Kohut's view of narcissistic megalomania as an aspect of normal mental development, by contrast with Otto Kernberg's consideration of such grandiosity as a pathological distortion of normal psychological development.

Controversy

The extent of controversy about narcissism was on display when the committee on personality disorders for the 5th Edition (2013) of the Diagnostic and Statistical Manual of Mental Disorders recommended the removal of Narcissistic Personality from the manual. A contentious three-year debate unfolded in the clinical community with one of the sharpest critics being John Gunderson, who led the DSM personality disorders committee for the 4th edition of the manual.

The American Psychiatric Association's (APA) formulation, description, and definition of narcissistic personality disorder, as published in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Ed., Text Revision (DSM-IV-TR, 2000), was criticised by clinicians as inadequately describing the range and complexity of the personality disorder that is NPD. That it is excessively focused upon "the narcissistic individual's external, symptomatic, or social interpersonal patterns – at the expense of ... internal complexity and individual suffering", which reduced the clinical utility of the NPD definition in the DSM-IV-TR.

In revising the diagnostic criteria for personality disorders, the work group for the list of "Personality and Personality Disorders" proposed the elimination of narcissistic personality disorder (NPD) as a distinct entry in the DSM-5, and thus replaced a categorical approach to NPD with a dimensional approach, which is based upon the severity of the dysfunctional-personality-trait domains. Clinicians critical of the DSM-5 revision characterized the new diagnostic system as an "unwieldy conglomeration of disparate models that cannot happily coexist", which is of limited usefulness in clinical practice. Despite the reintroduction of the NPD entry, the APA's re-formulation, re-description, and re-definition of NPD, towards a dimensional view based upon personality traits, remains in the list of personality disorders of the DSM-5.

The Norwegian study, Validity Aspects of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Narcissistic Personality Disorder Construct (2011) concluded that narcissism should be conceived as personality dimensions pertinent to the full range of personality disorders, rather than as a distinct diagnostic category. In the study Debates on the Narcissism Conundrum: Trait, Domain, Dimension, Type, or Disorder? (2012) examining the past literature about NPD, the researchers Renato Alarcón and Silvana Sarabia concluded that narcissistic personality disorder "shows nosological inconsistency, and that its consideration as a trait domain needed further research would be strongly beneficial to the field."

Lie point symmetry

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