Straight from the psychotherapist's "Bible": DSM-IV !!

Narcissistic Personality Disorder
These words relating to narcissism (as a disorder) are worth reading, I think.

While grandiosity is the diagnostic hallmark of pathological narcissism, there is research evidence that pathological narcissism occurs in two forms, (a) a grandiose state of mind in young adults that can be corrected by life experiences, and (b) the stable disorder [described elsewhere in DSM-IV], which is defined less by grandiosity than by severely disturbed interpersonal relations.

The preferred theory seems to be that narcissism is caused by very early affective deprivation, yet the clinical material tends to describe narcissists as unwilling rather than unable, thus treating narcissistic behaviors as volitional -- that is, narcissism is termed a personality disorder, but it tends to be discussed as a character disorder. This distinction is important to prognosis and treatment possibilities. If NPD is caused by infantile damage and consequent developmental short-circuits, it probably represents an irremediable condition. On the other hand, if narcissism is a behavior pattern that's learned, then there is some hope, however tenuous, that it's a behavior pattern that can be unlearned. The clinical literature on NPD is highly theoretical, abstract, and general, with sparse case material, suggesting that clinical writers have little experience with narcissism in the flesh. There are several reasons for this to be so:

-- The incidence of NPD is estimated at 1% in the general population, though recent research hasn't been able to discover the basis of this estimate.
-- Narcissists rarely enter treatment and, once in treatment, progress very slowly. We're talking about two or more years of frequent sessions before the narcissist can acknowledge even that the therapist is sometimes helpful. It's difficult to keep narcissists in treatment long enough for improvement to be made -- and few people, narcissists or not, have the motivation or the money to pursue treatment that produces so little so late.
-- Most clinical writers seem unaware that narcissists' self-reports are unreliable. This is troubling, considering that lying is the most common complaint about narcissists and that, in many instances, defects of empathy lead narcissists to wildly inaccurate misinterpretations of other people's speech and actions, so that they may believe that they are liked and respected despite a history of callous and exploitative personal interactions.

[from Diagnostic and Statistical Manual of Mental Disorders, 4th edition, 1994, commonly referred to as DSM-IV, of the American Psychiatric Association. European countries use the diagnostic criteria of the World Health Organization.]

Further analysis of this subject forthcoming in future blog postings.