The monster in the mirror

If you like what you see, you could be dangerous. Yvonne Roberts investigates cli
nical narcissism
September 16, 2007
Claire is 47, a mother of two, and recently divorced. Her ex-husband, Dan, 58, w
as a successful businessman when they met 12 years ago. By the time we separated,
she says, I no longer knew what was true and what was a lie. I was emotionally ba
ttered, my confidence was in shreds, and I felt the person I had once been had s
omehow been sucked out of me by Dans bullying and manipulation.
A friend studying to be a psychotherapist suggested she look up narcissism on th
e internet. I began reading everything I could, and that led me to narcissistic p
ersonality disorder [NPD]. It made me realise that not only me but a couple of f
riends had experienced something similar in their relationships. NPD is said to
be particularly prevalent among the driven and ambitious.
At first, I thought Dan was a really secure guy, with normal values and objective
s. A person with NPD will be whatever you want him to be as long as it suits him
. Then, suddenly, youre in exile, and youre left perplexed, blaming yourself for w
hat youve apparently done wrong. I was either worshipped or, more often, undermin
ed. At the same time, whatever traits you have that he finds attractive and ther
efore threatening to his own sense of superiority he will set out to destroy.
As the marriage progressed and I discovered more of his lies, the angrier he beca
me and the more he drank, Claire recalls. I begged him to get help for the sake of
the children not realising that the root of the problem was probably NPD.
Dan agreed, but later Claire found out that the time he was supposed to be spend
ing in alcohol-addiction centres and on anger-management courses, he was with hi
s girlfriends. Healthy narcissistic tendencies are life-preserving, she says. But w
hen the narcissism is extreme, its hugely destructive to everyone around. Its a fo
rm of emotional abuse that isnt properly recognised yet, and it ought to be. Narc
issists play a subtle, long-term psychological game that is truly deadly to the
other persons psyche.
Claire is one of a growing number of people in Britain who are convinced their p
artner, boss or one of their parents has NPD.
Although Freud published his study On Narcissism in 1914, NPD wasnt officially re
cognised as a personality disorder in the US until the 1980s. Seen as the high-f
lyers disease, often allied with drugs, gambling and alcohol abuse, it is now a m
ulti-billion-dollar industry. There are hundreds of therapists and support group
s for the children, employees and partners of people with NPD, as well as websit
es and self-help books with titles such as Help! Im in Love with a Narcissist and
Children of the Self-Absorbed: A Grown-Ups Guide to Getting over Narcissistic Pa
rents.
In the UK, there has been an ambivalent response to the apparent problem. Partly
because, for a number of years, some psychiatrists questioned whether NPD and o
ther personality disorders existed at all, while others believed they were simpl
y untreatable. The change came in the 1990s, spurred by the governments growing c
oncern for the safety of the public after several attacks by people suffering fr
om severe and dangerous personality disorders, and demands that they should be tre
ated.
So what exactly is NPD? How easy is it to distinguish between a badly behaved ro
gue who may really love you and a man, or woman, who has become highly skilled i
n camouflaging their lack of authentic emotion? And is there a cure?
In Greek mythology, Narcissus, the handsome young Thespian, epitomises the conce
pt of destructive self-love. According to the legend, Echo the nymph falls in lo
ve with Narcissus, but since she has been stripped of the ability to form her ow
n words, she can only repeat what she hears. Narcissus, enamoured of his image r
eflected in a pool, addresses himself and says, I love you, repeated longingly by
Echo. Narcissus, however, is too self-absorbed to see, hear or react. He eventua
lly dies of languor, neglecting to eat or drink. Echo dies from a broken heart.
In the myth, falling in love with ones own image is seen as punishment for being
incapable of loving another. In reality, NPD, at its most extreme, can lead to m
urder. In 2004, the public-school boy Brian Blackwell, 19, stabbed and bludgeone
d his parents to death at their home in Merseyside before embarking on a 30,000 s
pending spree. He was obsessed with fantasies of success, power and brilliance,
claiming, for instance, that he was a world-class tennis player. He was diagnose
d as suffering from NPD.
NPD appears to affect men more than women. A person with NPD is spectacularly la
cking in curiosity or concern for others, but can easily simulate both if it ens
ures the continuation of what psychiatrists call the narcissistic supply of uncrit
ical admiration and adulation.
In Narcissism: Denial of the True Self, first published in 1985, the American ps
ychiatrist Dr Alexander Lowen refers to the case of Erich, brought to him by his
girlfriend, Janice. Dr Lowen asks Erich about his feelings. Feelings! Erich repli
es. I dont have any feelings I programme my behaviour so that it is effective in th
e world.
Erich describes his mother as perpetually on the verge of hysteria, provoked by
a father who was cold and hostile. Dr Lowen diagnoses that Erich has deadened hi
s emotions in response to his parents dysfunctional relationship. He writes: The n
arcissistic image develops in part as a compensation for an unacceptable self-im
age and, in part, as a defence against intolerable feelings a state of living dea
th. Erich, in his relationship with Janice, has continued to shut down feeling wh
ile exercising power. He got her to love him without any loving response on his p
art, Dr Lowen explains. Such exploitativeness is common to all narcissistic person
alities.
So, how do you know if a person has NPD? Mental-health professionals in Europe a
nd the US draw on two sets of guidelines that are regularly updated by internati
onal groups of psychologists and psychiatrists to help make a diagnosis. The ICD
-10, the World Health Organizations classification of mental and behavioural diso
rders, published in 1992, lists nine categories of personality disorder, but doe
s not include NPD.
In the US, the Diagnostic and Statistical Manual of Mental Disorders was first p
ublished by the American Psychiatric Association in 1952, in part to provide a b
enchmark for insurance companies handling medical claims. The fourth and current
version (DSM-IV), published in 1994, lists 10 categories of personality disorde
r (see page 27) of which NPD is one. (DSM-V is due to be published in 2010.) DSM
-IV also gives a list of nine characteristics, of which a person has to have at
least five before NPD is considered.
The nine include a grandiose sense of self-importance; preoccupations with fanta
sies of success, power, brilliance, beauty or ideal love; a belief that he or sh
e is special, only understood by other special people; a need for admiration; a sens
e of entitlement or unreasonable expectations of favourable treatment; exploitat
ive, taking advantage of others to achieve his or her own ends; unwillingness to
recognise or identify with the needs of others; envious of others, or thinks ot
hers are envious of him or her, and arrogance.
In its most extreme form, known as malignant narcissism, paranoia and physical a
ggression may also be displayed: Stalin, Hitler and Saddam Hussein come to mind.
In the rich and successful, many of the characteristics of NPD are of course se
en as positive attributes. In a 2005 study, the psychologists Belinda Board and
Katarina Fritzon at Surrey University found that three personality disorders, in
cluding NPD, were more common in managers than in criminals.
In an article in The New York Times, Board explained: A smattering of egocentrici
ty, a soupon of grandiosity, a smidgen of manipulativeness and lack of empathy, a
nd you have someone who can climb the corporate ladder and stay on the right sid
e of the law, but still be a horror to work with. Add a bit more of those charac
teristics, plus lack of remorse and physical aggression, and you have someone wh
o ends up behind bars.
Whats important is the degree to which a person has each ingredient or characteris
tic, and in what configuration.
Since many people may belong to more than one category of personality disorder,
DSM-IV divides the categories into three clusters. NPD belongs to Cluster B dram
atic, emotional or erratic types, embracing histrionic, narcissistic, antisocial
and borderline personality disorders.
The characteristics and categories provide clues, but not a definitive diagnosis,
says Professor Eddie Kane, the director of the Personality Disorder Institute at
Nottingham University. While its clear when a person is psychotic or schizophreni
c, we have to be wary in diagnosing personality disorder. Putting a label on som
eones behaviour that may have an enormous impact on their lives has to be very ca
refully considered.
In a paper published this May in The British Journal of Psychiatry, Professor Pe
ter Tyrer and colleagues from the department of psychological medicine at Imperi
al College London wrote unequivocally: The assessment of personality disorder is
currently inaccurate, largely unreliable, frequently wrong and in need of improv
ement.
And the psychiatrist Dr Paul Moran of the Institute of Psychiatry in London, the
author of several papers on personality disorders, says: A number of biases can
distort the assessment of personality. For instance, there is evidence to sugges
t that the term personality disorder may itself be a label applied to unlikable pa
tients who are regarded as difficult. A person can be supremely confident, super
ficially charming, and only choosing to treat people as stepping stones in his l
ife. But does that mean hes displaying signs of NPD? At present in the UK, our un
derstanding of the characteristics, causes and treatment of NPD are very rudimen
tary. Its still only a theory about how some people might behave. However, I have
no doubt that individuals can and do manifest these traits.
In 2006, a team that included Professor Jeremy Coid of the forensic-psychiatry u
nit at St Bartholomews Hospital, London, published an assessment of the prevalenc
e of personality disorders in Great Britain in the British Journal of Psychiatry
. The study concluded that they are common, affecting nearly 1 in 20 people (4.4%)
previous estimates have given a higher figure of 10-13%. What the study failed
to find, however, was a single case of NPD. (DSM-IV estimates that about 1% of t
he US population has NPD.)
That does not mean it doesnt exist in the UK, Professor Coid says. The questionnaire
s used to pick it up do not work very well because not many people admit to thes
e criteria. People dont like to admit they are arrogant and envious.
One reason why people with NPD appear few in number is that they are treatment r
esistant. Put plainly, they dont believe they have a problem, so they rarely pres
ent themselves for help.
Shmuel Sam Vaknin, 46, has been diagnosed with narcissistic personality disorder t
wice. He is unusual in that he accepts the diagnosis, uniquely turning it into a
way to provide an international source of narcissistic supply. Born in Israel,
since the mid-1990s he has written extensively about himself and NPD, both on th
e internet and in books, including his magnus opus, Malignant Self Love Narcissi
sm Revisited. Hundreds interact daily on his websites. He insists that he offers
help and advice only to ensure a narcissistic supply of attention that confirms
his superiority, intelligence and specialness not because he cares.
Vaknin is an unsettling combination of the chilling and the charming. In convers
ation, its hard to disentangle truth from the narcissists tools of the trade exagg
eration, flattery, grandiosity and the display of fake vulnerability and self-pi
ty to elicit sympathy. He is a verified economist, award-winning writer, poet, p
hilosopher, journalist and financial consultant. He is also, he says, a failure.
On one of his websites, he writes: I have lived in 12 countries, worked in 50, a
nd I dont think there is one that will take me back. I consider the businesses I
drove to bankruptcy with my narcissistic temper tantrums and superiority contest
s The fortunes I squandered I cherished and revelled in my self-annihilation.
Vaknin lives in Skopje, Macedonia. He is one of five siblings, but he hasnt seen
his family for over a decade. His father was a construction worker from Morocco,
who suffered from clinical depression. Violence was the main channel of communic
ation, Vaknin says. His mother was from Turkey. She believed she was a prodigy, b
ut had to leave school and sell shoes to rich people at the age of 14. I have an
IQ of 180 and it was her enormous misfortune to have me as her first-born, Vaknin
says. My parents were ill-equipped to deal with normal children, let alone the g
ifted. I was her ambassador to the world, but I also constituted a threat. Vaknin
says his mother is a narcissist. In a short story Nothings Happening at Home fic
tion based on his own childhood, he describes the life of a six-year-old with a
violent, resentful and unpredictable mother. mother takes a broom to me and beats
me forcefully on the back and all the neighbors [sic] watch on the floor is this
large yellow puddle in which I stand. Mummys broom gets all wet and the neighbor
s [sic] laugh She takes down my trousers and I am exposed to the jeering crowd, d
renched and naked. It isnt a good day, this one.
Children with narcissistic parents are objectified. They are like circus animals,
performing on order, to extract a little love, Vaknin says. I dont hate my mother.
I hate what her illness did to her. I began to live as if life is a film and Im
playing out a script, totally detached to fend off hurt and injury. Now, I am a
monster. Underneath the skin, I am a hideously deformed individual. When you loo
k at the quadriplegic, you can understand if he can only wink the quadriplegic i
s a marathon runner compared to me and my emotional disability.
At 17, Vaknin left home to join the army and never returned. He was first diagno
sed with NPD at 26. He was living in opulence in London with his then wife, Nomi
. On her insistence, he visited a psychiatrist. When I first received the diagnos
is, I was mortified and very frightened. Then, as a typical narcissist, I though
t, Can I use the diagnosis as leverage to become famous? Make money? The answer wa
s yes.
In 1995, Vaknin was diagnosed for a second time by a psychiatrist in an Israeli
jail. He was serving 11 months for fraud, trying to manipulate the price of stoc
k. In jail he began to write Malignant Self Love Narcissism Revisited.
I am no healthier today than I was when I wrote that book. My disorder is here to
stay, the prognosis is poor and alarming. The vast majority of narcissists end
up at the very top or the very bottom derelict, desolate, schizoid, bitter, deca
ying and decrepit. You wont find any in the middle. My narcissism is much worse t
han it used to be. As my capacities dwindle, minute by minute, the gap between r
eality and grandiosity becomes bigger and bigger. The larger the gulf, the more
narcissistic defences are needed.
I am an abject failure in comparison to my potential. I should have been a public
intellectual. But people dont like looking in the mirror, and I like forcing the
m to look.
Vaknin has been married to his second wife, Lidija, 37, for five years, and they
have been together for 10. She is Macedonian. Lidija would like a child. In res
ponse, Vaknin says he is a cerebral narcissist, relying on his intellect to attr
act a narcissistic supply. He is not much interested in sex. For Lidija, our rela
tionship is a constant war of attrition, Vaknin says. I think she is very tired. S
he says sometimes she is being erased. But she stays, so I must respond to some
of her emotional needs. A narcissist infiltrates his partners like acid, he expla
ins. If she fails to erect strong defences, the narcissist takes over, forcing th
e eviction of the persons original self.
Vaknin says narcissism recruits as it infects. Narcissism creates a bubble univer
se similar to a cult. In the bubble, special rules apply that do not always corr
espond to an outer reality. The narcissist conditions people, so the victims com
e to assimilate the narcissists way of thinking. You can abandon the narcissist b
ut the narcissist never abandons you. We are like body snatchers.
Lidija Vaknin appears undaunted. Some people think Im crazy to stay with him, but
Ive discovered I am strong. At the beginning, several times a day, I wanted to le
ave. Now, its easier. My father was a narcissist and very physically abusive. My
previous partner was violent. I learnt to read the eyes, the mouth, the body lan
guage. I dont feed Sams need for admiration. We talk and tackle the issue. Sometim
es I have to repeat what I say many times, and sometimes I give up trying.
On occasions, he is untouchable. If hes in that state, I dont even try to communica
te. He has his own world, and if I try to enter it, he explodes into many pieces
. We are a good match. Sam is clever and funny. He makes jokes about himself, wh
ich is rare for a narcissist.
Lidijas sister, Meri Petrov, says of Vaknin: Ive never met a man like him. He knows
how to be a good friend, but one minute everything is going well, then suddenly
he says horrible things and has a terrible anger. One minute hes kind, the next
I cant define him. My sister has found a way to live with him, I dont know how.
Vaknin believes his NPD was triggered by childhood trauma and abuse. Every human
being develops healthy narcissism. That is rendered pathological by abuse. By abu
se I mean refusal to acknowledge the emerging boundaries of the individual. Smoth
ering, doting and excessive expectations are as abusive as beating and incest.
Dr Bob Johnson, consultant psychiatrist and co-founder of the James Nayler Found
ation to further research into personality disorders, agrees. Personality disorde
rs are all to do with software. The trauma a person has experienced in childhood
. They have nothing to do with predispositions or genetics or the type of societ
y in which a person lives. Address the trauma and the personality disorder evapo
rates. But the individual first has to want to change.
Professor Eddie Kane disagrees. He says the causes of personality disorders, inc
luding NPD, may turn out to be multi-factorial. Biological, psychological and soci
al-risk factors may have differing impacts on different individuals. Dr Joel Par
is, professor of psychiatry at McGill University, Montreal, suggested 10 years a
go that: Personality disorders are pathological amplifications of normal personal
ity traits different social structures tend to reinforce some traits and discoura
ge others. The DSM-IV definition of personality disorder refers to behaviour that
deviates markedly from the expectations of the individuals culture but could a nar
cissistic culture act as a hothouse for NPD?
The American Dr Theodore Millon is an internationally renowned psychologist and
psychiatrist. In Personality Disorders in Modern Life (2000), written with Roger
Davis, he argued that pathological narcissism gained prominence only in the lat
e 20th century. Individuals in less advantaged nations are too busy trying (to sur
vive) to be arrogant and grandiose. Millon and Davis attribute pathological narci
ssism to a society that stresses individualism and self-gratification at the expe
nse of the community, namely the United States. Others see western culture devalu
ing and undermining the very elements, home and family life, work, self-reliance
and healthy personal relationships that act as protective factors against narci
ssism.
An extensive study showing the significant growth of narcissism in the US was pu
blished earlier this year. Headed by Jean Twenge, professor of psychology at San
Diego State University, it assessed the responses of 15,234 college students, b
etween 1987 and 2006, to a test called the Narcissistic Personality Inventory. I
t attempts to rate changes in areas such as self- esteem, assertiveness and whet
her individuals see themselves as leaders. As part of the inventory, students ar
e asked to agree or disagree with statements such as, I think I am a special pers
on. The study found, an alarming rise in narcissism and self-centredness. It discov
ered that the average college student scored higher in narcissism than 65% of st
udents 19 years earlier. Weve seen a distinct increase in narcissism, Twenge says. I
s some of it healthy narcissism? Im not sure there is such a thing.
Twenge is also the author of Generation Me: Why Todays Young Americans Are More C
onfident, Assertive, Entitled and More Miserable than Ever Before, published las
t year. The rise in narcissism has very deep roots, Twenge says. We fixate on self-
esteem and unthinkingly build narcissism because we believe the needs of the ind
ividual are paramount.
Yet, in highly narcissistic societies, millions do not develop NPD why not? The
psychologist Dr Jeffrey Young suggests an antidote might be: Unconditional parent
al love that includes fair and firm boundaries, consistent discipline and a resi
stance to the inclination to spoil.
In one study, however, NPD was also found in countries in Asia and Africa so is
it truly a modern disease of the affluent? Or is Sam Vaknin correct in believing
it has always existed, whether among subsistence farmers in Africa or intellectu
als and socialites in Manhattan? As the causes are, as yet, unclear can NPD be cu
red?
Dr Young founded the Schema Therapy Institute in New York more than 20 years ago
. It integrates elements of cognitive behaviour therapy and gestalt therapy to i
dentify and change self-defeating life patterns that he calls schema.
Dr Youngs methods have had some recognised success with NPD and other personality
disorders, previously regarded as untreatable. Schema therapy is based on the n
otion that we all have different parts of the self, known as modes (eg, easygoing,
angry, carefree, focused). For people with personality disorders, these are mor
e extreme and rigid, making it difficult for a person to move from one mode to a
nother.
In therapy, Young tries to engage the lonely shamed child that he sees as the sour
ce of the pain for an individual with NPD. All of which is difficult to achieve,
because even if a person agrees to treatment, Young points out dryly, he may wa
lk out unless the therapist keeps telling him hes simply the best; ordinary wont d
o.
A lot of people only come because theyve been sent by desperate partners or bosses
. Successful narcissists have something extra that means people tolerate their b
ad behaviour. The most dangerous is the unsuccessful narcissist. He doesnt have m
oney or power or charm, so hes fired a lot of the time. He drives more and more p
eople away, until he ends up alone and a very bleak person.
In treatment, people diagnosed with NPD are divided into two groups. In one are p
ure or thick-skinned narcissists. They have often been extremely spoilt and indul
ged and given no boundaries as children. In the second group are thin-skinned na
rcissists, such as Vaknin, who have grown up feeling unloved and unlovable. Youn
g says the former are almost impossible to help; the latter may respond to thera
py. If theres no change in a year, the chances of success are low. The person with
NPD will constantly try to prove he is superior to the therapist; that the prof
essional knows nothing.
Treatment may also involve drugs to combat additional mental-health problems suc
h as depression. Perhaps a lot of what were doing is completely wrong, Professor Co
nor Duggan, head of forensic mental health at Nottingham University, says bluntl
y. Sometimes in mental health, doing nothing is better than doing something, but
the imperative at present is to act. Without good-quality, rigorous clinical tri
als, we cant come up with proof of efficacy but investment in mental-health resea
rch is paltry in comparison to, say, cancer. Its vital that that changes.
I spoke to several psychiatrists about what a person should do if he or she beli
eves a partner has NPD. The response was unanimous: Leave. The children of narcissi
sts may find themselves attracted to narcissists, because they have had an early
training, says Dr Michael Isaac, consultant psychiatrist and senior lecturer in
psychological medicine at Guys, Kings and St Thomass medical schools in London. But
for other women, what often happens is a dovetailing of needs. A woman may feel
a sense of service and self-abnegation. Or she may entertain the notion that she
is his chosen one. Its only later the pleasure becomes pain.
Claire has no regrets about making her break. Her ex-husband, Dan, rejects the s
uggestion that he has NPD. If you have a lot invested in your choice of man, deni
al about his behaviour is easy. I thought it was my fault I couldnt reach him. Le
arning about NPD put together a lot of the pieces in our marriage that had refus
ed to fit before. I now know, if youre living with someone who has the disorder,
whatever you do will never be enough. Be warned.
Some names and personal details have been changed to protect identities
Carla, 40
Carla, 40, an only child, is divorced with a 12-year-old-son. Her mother, in her
late sixties, is French. Carlas parents separated when she was young, and she ha
d little contact with her father. Carla went into therapy two years ago, and now
believes her mother has NPD.
If your mother is a narcissist, its like living with a child who expects you to be
their doll, discarded when they lose interest. I only now realise the full exte
nt of the damage she did. Yet my instinct is still to please her. I still live f
ive minutes away and do as she demands.
My therapist told me to Laugh, let go and feel free. I honestly dont know how to do
that because Ive been conditioned to think only of what my mother wants from me.
When I was a child, my mother used to talk to others about me in a disparaging w
ay in front of me. I always had to say, Mama, Mama, five or six times before she p
aid any attention she was completely self-absorbed. Shes like a sponge. She soaks
up what she needs. When shes satiated, she can be unbelievably cruel. Now I know
its a disease, I feel sorry for her.
I never finished my education. My mother was a successful academic, but I dont thi
nk she wanted to risk me outshining her. So Ive drifted through life. I married y
oung and went for what was familiar. My husband was charismatic, domineering, na
rcissistic, and he put me down everything I was used to. He had an affair, so I
divorced because my mother told me to. I got married again, to a decent man, but
I was so used to extreme emotions I got bored.
My therapist asked me where I saw myself in two years time. The thought had never
occurred to me that I had the right to think like that. Thats what narcissism doe
s to another human being. Id love to meet others who have had the same experience
and come through it. Maybe they can show me how to live like a human being who
isnt in a form of bondage that nobody else can see.
Leonie, 32
Leonie, 32, in advertising, met Tom, 36, four years ago. He was charming and made
me laugh. Within months he proposed. Then we moved in together, and he began to
change. If I said I was going for a run, he would sulk. Or he would go into a f
ury if Id arranged to see friends. For the sake of peace, I stopped exercising, s
topped living my own life. I was sure he was having an affair, but he said I was
being neurotic. I then found out hed been married before. He said he hadnt told m
e because he didnt know how Id react. I ended up feeling sorry for him. He was so
clever at manipulation.
When we met, I was confident and outgoing, with a good circle of friends. By the
time I left, Id dropped three dress sizes. I was insecure, anxious, isolated and
on antidepressants. Id almost lost all sense of myself.
Leonie later found out she was not the only woman to leave a relationship with T
om in a very different state from how she entered it. She was contacted through
mutual friends by Kate, 33, an architect. Kate was a mirror image of myself when
I first left, Leonie says. She was gaunt, depressed and tearful. Kates story was fam
iliar. A proposal after a few months; mood swings; affairs; emotional cruelty; j
ealousy. She walked out, but not before going through his e-mails. He boasted of
earning 70,000 a year. She found out it was 30,000 or less. He was living off her
income and accumulating debts. He lives in a fantasy world where he is the afflu
ent Action Man, admired by one and all, says Kate.
The women tracked down Toms previous wife, as well as two ex-girlfriends. Each le
ft him after a few years, but with enormous difficulty. Last year a friend direct
ed me to a website about narcissistic personality disorder, says Leonie. It was as
if the light had been switched on. The more I read, the more I realised this wa
s all about Tom. Hes already engaged to another woman. It will be her turn next.
How narcissistic are you?
If a person displays five or more of the following traits, they are likely to ha
ve narcissistic tendencies
A grandiose sense of self-importance (eg, exaggerates achievements and talents,
expects to be recognised as superior without commensurate achievements)
Is preoccupied with fantasies of unlimited success, power, brilliance, beauty or
ideal love
Believes that he or she is special and unique, and can only be understood by, or s
hould associate with, other special or high-status people (or institutions)
Requires excessive admiration
Has a sense of entitlement, ie, unreasonable expectations of especially favourab
le treatment or automatic compliance with his or her expectations
Is interpersonally exploitative, ie, takes advantage of others to achieve his or
her own ends
Lacks empathy: is unwilling to recognise or identify with the feelings and needs
of others
Is often envious of others or believes that others are envious of him or her
Shows arrogant, haughty behaviours or attitudes