It should be understood that symptoms of narcissistic personality disorder represent a spectrum. Most people have their moments of excessive self-criticism or grandiosity, of envying others or of having fragile self-esteem. These don’t represent a disorder, provided a person’s relationships to others or ability to function in the world is not constantly being impacted by these things.
One of the areas where this is the case is when adolescents are assessed for narcissistic personality disorder. Many teenagers would appear to have this condition due to their developmental stage and their fundamental work in forming an identity separate from caregivers at this time. Generally, though exceptions exist, narcissistic personality disorder is not diagnosed until people are in adulthood.
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The symptoms of this disorder make sense when considered together and they have to be considered as emanating from the inability to individually maintain a strong image of self. People with this disorder constantly look to others to mirror them or provide praise. When they attempt this process on their own, they lack a strong core set of beliefs about their own worth and instead encounter self-criticism.
To deflect from the constant self-loathing, narcissists focus on outward shows of personal worth, which could include bragging about possessions or accomplishments, seeking friends only among those who will admire them, or castigating others for having or being less. Expressed opinions about the self are often overestimation of importance or talent that lead to unrealistic and unjustified bragging. Grandiosity and boasting can cause the most confusion because these things sound like high self-esteem, but they really represent the opposite and are an attempt to get others not to see the core lowly self that is a source of perpetual shame.
Certain symptoms of this personality disorder further block people from the path of having real relationships with others. Many narcissists do marry and sometimes marry other narcissists, which creates constant mirroring between the couple. Children who come into this picture may be treated as prizes, and if they are accomplished, they may receive affection from narcissistic parents, but only if they meet parental standards.
Probably the most disliked symptoms of narcissistic personality disorder are the tendency to have no empathy for others and to use and exploit people for personal gain. Someone with this condition could feign deep friendship with another to get a job promotion, or could lose interest in a friend who suddenly has life problems and seems to need sympathy. Narcissism ultimately represents failure to understand belonging with the rest of the human race, so sympathy with it is impossible. As long as a person with this disorder remains untreated, on the outside he is special, elite and different, and on the inside, he is so terribly unworthy he can never do or be enough to hide his shame. At either pole, he is alone with little real closeness to others.