Narcissism in clinical medicine

Sve je više govora o trendu porasta narcističnih osobina u modernom društvu koje takve osobine njeguje i podržava. Grandiozan nastup, ambicioznost, manjak empatije, potreba za uspjehom, moći i bogatstvom, samo su dio spektra narcističnih osobina. Narcizam se smatra moralno upitnom i nepoželjnom osobinom, no jedna doza zdravog narcizma potrebna je za normalno svakodnevno funkcioniranje. Zdravi narcizam dio je normalne izgradnje samopouzdanja i daje potrebu za uspjehom i ostvarenjem u svim aspektima života. Patološki narcizam vezan je uz poremećaj regulacije samopouzdanja i afekta te stoga narušava integritet normalnog funkcioniranja. Najteži oblik patološkog narcizma je narcistični poremećaj ličnosti zbog trajno usađenih narcističnih osobina koje su dugotrajne i stabilne. Tema ovog preglednog rada je narcizam u kliničkoj medicini te je fokus stavljen na objašnjenje narcističnog poremećaja ličnosti. Iako je ovaj poremećaj jedan od rjeđih poremećaja ličnosti, mnogobrojni radovi su pokazali da se njegova prevalencija u općoj populaciji kreće oko 1% što ga čini učestalom pojavom. Početkom 20. stoljeća počinje razvoj proučavanja patološkog narcizma čiji su nositelji bili psihoanalitičari, a svoj vrhunac doživljava objavljivanjem višegodišnjeg istraživanja Kernberga i Kohuta. Etiologija poremećaja još uvijek nije razjašnjena te postoje brojne teorije, no u posljednje vrijeme naglasak se stavlja na neurobiološka istraživanja. U postavljanju dijagnoze poremećaja pomažu DSM dijagnostički kriteriji u kojima su naglašene osobine grandioznog tipa narcizma. Grandiozan tip prezentira se pompoznim nastupom, osjećajem superiornosti i jedinstvenosti kojima skrivaju manjak samopouzdanja. Jedna od kritika DSM klasifikacije je nedovoljna zastupljenost kriterija za postavljanje dijagnoze vulnerabilnog tipa narcizma. Naizgled potpuno drugačiji, vulnerabilni tip obuhvaća profil hipersenzitivnih introverta, no u podlozi poremećaja također leži nisko samopouzdanje i osjećaj srama. Terapija narcističnog poremećaja ličnosti izuzetno je zahtjevna zbog nezainteresiranosti pacijenta za liječenjem i negiranjem problema. Osnovu terapije još uvijek čini individualna psihoterapija.There is a lot of talk lately about an increase in narcissism in modern society that supports narcissistic traits. Grandiose and ambitious behavior, lack of empathy, excessive need for success, power and wealth are just a part of the broad spectrum of narcissistic traits. Narcissism is a trait that can be considered as a morally questionable and undesirable behavior, but narcissism is required for ordinary functioning in everyday life. Healthy narcissism is a part of normal self-esteem regulation and it provides the desire for success and achievement in every aspect of our life. Pathological narcissism is associated with self-esteem and affect dysregulation, and it disrupts the integrity of normal functioning. The most serious form of pathological narcissism is a narcissistic personality disorder due to narcissistic traits that are long-lasting and permanent. The topic of my review article is „Narcissism in Clinical Medicine“, thus the focus is on the narcissistic personality disorder. Even though this disorder is one of the rarest among the personality disorders, numerous studies found that its prevalence in the general population is around 1%. Even these low figures make NPD a highly frequent disorder. The early psychoanalytic studies on narcissism started in the beginning of the 20th century, with the works of psychoanalysts Kohut and Kernberg as the studies’ peak. The origins of NPD are still not clear, and there are various theories that try to explain the etiology of the disorder. Recent studies suggest the importance of neurobiology. DSM diagnostic criteria help in recognizing the grandiose type of narcissism. Grandiose narcissist is an individual who represents himself/herself with a showy attitude and a sense of superiority and self-importance in order to hide low self-esteem. One of the criticisms of DSM diagnosis is an inadequacy in diagnostic criteria for vulnerable narcissists that present themselves as hypersensitive introverts. Although vulnerable and grandiose narcissists seem to be completely different personalities, they both meet the criteria for grandiosity and have low self-esteem and sense of shame. Narcissistic patients deny their problems, and are not interested in solving them, which makes therapy really challenging. Nevertheless, psychotherapy remains the main treatment for NPD