A. A pervasive pattern of grandiosity (in fantasy and behavior), need for admiration, and lack of empathy, beginning in early adulthood and present in a variety of contexts, as indicated by five or more of the following:
1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements) 2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love 3. Believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions) 4. Requires excessive admiration
5. Has sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with personal expectations) 6. Is interpersonally exploitative (i.e., takes advantage of others to achieve personal ends) 7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others 8. Is often envious of others or believes that others are envious of self 9. Shows arrogant, haughty behaviors or attitudes
1. Primary feature is arrogance with a grandiose view of self-importance. 2. Under the surface they feel intense shame and fear of abandonment. 3. Represent 1% of the population and affects more women than men. 4. Axis I comorbidities are depressive disorders, substance use disorders, and anorexia nervosa. 1. Can be the result of childhood neglect and criticism because the child does not learn that other people can be sources of comfort and support.
1. Remain neutral; avoid engaging in power struggles or becoming defensive in response to the patient's disparaging remarks. 1. Convey unassuming self-confidence.