The elimination of NPD from the DSM would be a disaster


Apparently, the removal of Narcissistic Personality Disorder (DSM-V code 301.81; ICD-10 code F60.81) from the Diagnostic and Statistical Manual of Mental Disorders is still being considered.   Sam Vaknin talks about it in this video.

I think its removal would be disastrous. It already scares me that narcissism seems to be increasingly regarded as an advantage in today’s winner-take-all society and that we even have a potential US President who is a poster boy for malignant NPD. Trump has even been given the NPD label by many mental health professionals. Yet he still remains popular and is a serious contender for our next President.

But narcissism (not the healthy, but the pathological type) is definitely not a positive thing. Narcissists are actually miserable people even if they become successful (and many of them do not). These are people without a real sense of self, who have constructed a false one to compensate and must feed off others like vampires to keep their false self intact. They do others a lot of damage, even if they think they don’t have a problem. Under the facade, these are people who have a vast well of emptiness inside and if the false self is removed through loss of narcissistic supply, will become deeply depressed, possibly psychotic, and even suicidal. NPD is a serious mental illness, but I think people tend to forget that, because on the surface, people with this disorder can seem so functional. SEEM is the operating word here.

Many self-help books, especially those that tell you how to be successful, encourage you to develop narcissistic traits. I think these books are dangerous, not only because they encourage people to become narcissists, but also because they have caused a shift in thinking about NPD to the point that many no longer consider it a mental illness and in fact think of it as something to strive for. We need to stop pretending narcissism isn’t a problem. More attention needs to be paid not only to the damage narcissists cause others, but also to the internal world of the NPD, which is a painful and bleak one. NPD is a serious mental illness, not a “personality type.” Its removal from the DSM would cause untold damage to the world.

We also need more mental health specialists who are actually trained to treat people with NPD. I think part of the reason why it’s under consideration for removal is because most therapists don’t want to treat people with NPD. If you have the diagnosis, you are shown the door. They don’t want to deal with you and assume you are incurable. Hence, there are more narcissists walking around doing damage to themselves and others than ever before. I don’t think the non-malignant type of narcissist is as incurable as people think; it’s just because it isn’t an easy disorder to treat and therapists don’t want to be bothered working with people who have it. Old-school psychiatrists and psychologists such as Kohut, Kernberg, Masterson, and Lowen treated people with NPD successfully in their practices, but we seem to have forgotten that and just assume it’s incurable and worse, that it’s not even a mental illness but a personality type. This needs to change!