One of the original diagnoses attributed to John Hinckley Jr. in finding him not guilty “by reason of insanity” in the 1981 shooting of President Ronald Reagan was narcissistic personality disorder. He was also deemed to have co-occurring major depressive and psychotic disorders.
In hearings earlier this year to determine whether Hinckley should be allowed to have extended visits with his mother in Kingsmill in Williamsburg, leading eventually to full-time “convalescence leave,” his doctors declared him to be in full remission, stating that he has gone 16 years without delusional thinking. They did note that he retained narcissistic personality traits. The term “traits” means he meets insufficient criteria for a diagnosis of the full-blown disorder.
What does this mean? Loren Council, a Williamsburg psychologist, described the disorder and its traits. According to the DSM manual (Diagnostic and Statistical Manual of Mental Disorders), narcissistic personality disorder belongs to the Axis II class of mental disorders, whereas bipolar disorder and schizophrenia are classified as Axis I.
Council explains that personality disorders are “considered woven into who the person is. If I’m depressed, I can be made aware of it. It’s something foreign to me and something I don’t like. A personality disorder, by contrast, is ‘what I am.'”
“The main issue with narcissism generally is that they aren’t that interested in treatment because it doesn’t feel like a problem,” says Council. “They can be very successful with intelligence and other skills, and with the desire to be better than others.”
Personality disorders are typically diagnosed in early adulthood, and shouldn’t be made any earlier. “It would be easy to get carried away with teens,” says Council.
The essential defining characteristic of narcissistic personality disorder is an inner sense of shame or badness that’s defended against with grandiosity, with a sense of being special or unique, and the need to have others recognize it, he says.
Those with the disorder are more likely to seek treatment if it’s co-occurring with another diagnosis, or in their 30s, when they may have an ongoing sense of dissatisfaction despite high achievement.
Therapy aims to have the individual acknowledge the inner shame — “it can be anything, just a sense that there is something flawed inside of one” — and help them to see the grandiosity as a dissent against that.
Most of the research into treatment is in the psychoanalytic tradition rather than through medications. “The therapist establishes the rapport, which goes along with strong idealization — ‘If I’m special then the person to help me must be super-special,'” says Council, noting that the condition is rare compared to borderline personality disorder.
Typically, narcissistic personality disorder causes problems in personal life through a lack of empathy; and in professional life from cheating or claiming credit for others’ work. By itself it has no connection to violence, says Council.
