Generally, the symptoms of NPD also impair the persons psychological abilities to function socially, either at work or at school, or within important societal settings. The DSM-5 indicates that, in order to qualify as symptomatic of NPD, the persons manifested personality traits must substantially differ from social norms. ICD-11 and ICD-10
In the International Statistical Classification of Diseases and Related Health Problems, 11th Edition ICD-11 of the World Health Organization (WHO), all personality disorders are diagnosed under a single title called "personality disorder". The criteria for diagnosis are mainly concerned with assessing dysfunction, distress and maladaptive behavior as opposed to attributing specific personality traits. In the previous edition, the ICD-10, narcissistic personality disorder (NPD) is listed under the category of "other specific personality disorders". This means similarly to the ICD-11, the ICD-10 required that cases otherwise described as NPD in the DSM-5 would only need to meet a general set of diagnostic criteria. Associated features
People with NPD exaggerate their skills, accomplishments, and their degree of intimacy with people they consider high-status. A sense of personal superiority may lead them to monopolize conversations, look down on others or to become impatient and disdainful when other persons talk about themselves. This behavior correlates to an overall worse functioning in areas of life like work and intimate romantic relationships.People with NPD have been observed to use psychosocial strategies, such as the tendency to devalue and derogate and to insult and blame other people, usually with anger and hostility towards peoples responses to their anti-social behavior.
Narcissistic rage
The term narcissistic rage was a concept introduced by Heinz Kohut in 1972. Narcissistic rage was theorised as a reaction to a perceived threat to a narcissists self-esteem or self-worth. Narcissistic rage occurs on a continuum from aloofness, to expressions of mild irritation or annoyance, to serious outbursts, including violent attacks.Narcissistic rage reactions are not necessarily limited to NPD. They may also be seen in catatonic, paranoid delusion, and depressive episodes. It was later suggested that narcissistic people have two layers of rage; the first layer of rage being directed constant anger towards someone else, with the second layer being self-deprecating. Object relations
In the second half of the 20th century, in contrast to Freuds perspective of megalomania as an obstacle to psychoanalysis, in the US and UK Kleinian psychologists used the object relations theory to re-evaluate megalomania as a defence mechanism. This Kleinian therapeutic approach built upon Heinz Kohuts view of narcissistic megalomania as an aspect of normal mental development, by contrast with Otto Kernbergs consideration of such grandiosity as a pathological distortion of normal psychological development.To the extent that people are pathologically narcissistic, the person with NPD can be a self-absorbed individual who passes blame by psychological projection and is intolerant of contradictory views and opinions; is apathetic towards the emotional, mental, and psychological needs of other people; and is indifferent to the negative effects of their behaviors, whilst insisting that people should see them as an ideal person.