Psychiatry

Narcissistic Personality Disorder

자기애성 성격장애

Pattern of grandiosity, need for admiration, lack of empathy

How common
Common
Typical age
Variable age

What is it?

Core neurobiological/psychological mechanisms of Narcissistic Personality Disorder.

Commonly affected: Limbic and prefrontal circuits

How it develops

  1. Genetic/environmental vulnerabilityFamily history and environmental factors for Narcissistic Personality Disorder
  2. Neural circuit changesAffected brain regions and neurotransmitter dysregulation
  3. Symptom emergenceCharacteristic mental symptoms appear
  4. Course/comorbidityCourse depends on treatment and comorbidities

Symptoms

  • Characteristic symptomsCore Narcissistic Personality Disorder features
  • Affective/behavioral changeAssociated mood/behavior changes
  • Functional impairmentSocial/work/academic decline

How it is examined

  • DSM-5 criteriaConfirm DSM-5 criteria for Narcissistic Personality Disorder
  • Rating scale/suicide riskStandardized rating scale and suicide assessment

Imaging

Mostly clinical diagnosis; brain MRI to rule out organic cause if needed.

  • Clinical diagnosis

Research fMRI findings reported; not used for diagnosis.

  • Research fMRI changes

Non-surgical care

  • PharmacotherapyDiagnosis-specific psychotropic medication
  • Psychotherapy (CBT)CBT effective for most conditions
  • Psychosocial supportFamily/social support, psychoeducation

Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.

When surgery is considered

Treatment-resistant or crisis

Procedures that may be discussed

  • Inpatient hospitalization
  • ECT/rTMS (if indicated)
  • Combination therapy

Outlook

Good with early treatment; risk of chronicity.

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