Narcissistic Personality Disorder in the DSM V

The DSM V re-defines personality disorders thus:
at
"The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits."

According to the June 2011 text of the DSM V, the following criteria must be met to diagnose Narcissistic Personality Disorder (in parentheses my comments):

Significant impairments in personality functioning in either identity, or self-direction (should be: in both.)

Identity

The narcissist keeps referring to others excessively in order to regulate his self-esteem (really, sense of self-worth) and for "self-definition" (to define his identity.) His self-appraisal is exaggerated, whether it is inflated, deflated, or fluctuating between these two poles and his emotional regulation reflects these vacillations.

(Finally, the DSM V accepted what I have been saying for decades: that narcissists can have an "inferiority complex" and feel worthless and bad; that they go through cycles of ups and downs in their self-evaluation; and ththis cycling influences their mood and affect.)

Self-direction

The narcissist sets goals in order to gain approval from others (narcissistic supply; the DSM V ignores the fact that the narcissist finds disapproval equally rewarding as long as it places him firmly in the limelight.) The narcissist lacks self-awareness as far as his motivation goes (and as far as everything else besides.)

The narcissist's personal standards and benchmarks are either too high (which supports his grandiosity), or too low (buttresses his sense of entitlement, which is incommensurate with his real-life performance.)

Impairments in interpersonal functioning in either empathy or intimacy (should be: in both.)

Empathy

The narcissist finds it difficult to identify with the emotions and needs of others, but is very attuned to their reactions when they are relevant to himself (cold empathy.) Consequently, he overestimates the effect he has on others or underestimates it (the classic narcissist never underestimates the effect he has on others - but the inverted narcissist does.)

Intimacy

The narcissist's relationships are self-serving and, therefore shallow and superficial. They are centred around and geared at the regulation of his self-esteem (obtaining narcissistic supply for the regulation of his labile sense of self-worth.)

The narcissist is not "genuinely" interested in his intimate partner's experiences (implying that he does fake such interest convincingly.) The narcissist emphasizes his need for personal gain (by using the word "need", the DSM V acknowledges the compulsive and addictive nature of narcissistic supply). These twin fixtures of the narcissist's relationships render them one-sided: no mutuality or reciprocity (no intimacy).

Pathological personality traits

Antagonism characterized by grandiosity and attention-seeking

Grandiosity

The aforementioned feeling of entitlement. The DSM V adds that it can be either overt or covert (which corresponds to my taxonomy of classic and inverted narcissist.)

Grandiosity is characterized by self-centredness; a firmly-held conviction of superiority (arrogance or haughtiness); and condescending or patronizing attitudes.

Attention-seeking

The narcissist puts inordinate effort, time, and resources into attracting others (sources of narcissistic supply) and placing himself at the focus and centre of attention. He seeks admiration (the DSM V gets it completely wrong here: the narcissist does prefer to be admired and adulated, but, failing that, any kind of attention would do, even if it is negative.)

The diagnostic criteria end with disclaimers and differential diagnoses, which reflect years of accumulated research and newly-gained knowledge:

The above enumerated impairments should be "stable across time and consistent across situations ... not better understood as normative for the individual’s developmental stage or socio-cultural environment ... are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma)."

Bibliography

Goldman, Howard H., Review of General Psychiatry, fourth edition,1995.Prentice-HallInternational, London.

Gelder, Michael, Gath, Dennis, Mayou, Richard, Cowen, Philip (eds.),Oxford Textbook of Psychiatry, third edition, 1996, reprinted 2000. Oxford University Press, Oxford.

Vaknin, Sam, Malignant Self-love: Narcissism Revisited, eighth revised impression, 1999-2006. Narcissus Publications, Prague and Skopje.

Westen, Drew et al. Refining the Construct of Narcissistic Personality Disorder: Diagnostic Criteria and Subtypes (Posted at http://ajp.psychiatryonline.org/pap.dtl)