Introduction
 
 The DSM-IV-R1 observes that many people who are highly successful behave in ways that we could call “narcissistic.”

The term itself derives from the Greek myth of Narcissus, a vain young man who spurned the love of the Nymph Echo and instead fell in love with the image of his face reflected back to him in the surface of a pond.  Unable to gain the attention of his mirror image—try though he might, Narcissus pined away and died of a broken heart.

However, not everyone who has an inflated opinion of their own importance can be diagnosed as having Narcissistic Personality Disorder (NPD).  The DSM-IV-R stipulates that these traits must be

Moreover, these traits must also cause Non-pathological narcissism is defined as the way in which a person relates to others and focuses on the issues of self-esteem and the ways in which an individual maintains the stability of their sense of self.  For someone with narcissistic tendencies, the focus is principally upon the self rather than on others.  What is referred to as “normal” narcissism is seen as an expression of self-preservation, self-regard, self- assertiveness with normal levels of entitlement and competitiveness, and competitiveness that includes an appropriate level of empathy and compassion.2  A person with healthy strong self-regard will not only have his or her best interests at heart, but will also have a concern that the rights and needs of others are met as well.  According to Stone, “appropriate self-regard and self-evaluation also mean that one’s sense of worth is accurate, such that one aims, occupationally, neither below nor above one’s capacities and, romantically, neither above nor below one’s approximate ranking in the hierarchy of potential mates.”3

Of course, too little self-regard is not a good thing for a person.  Low-self esteem can lead to feelings of inadequacy, inferiority, and incompetence and can cause any number of psychological difficulties.  So there appears to be a continuum of self-regard:  from not enough to way too much.  As with other aspects of the psyche, neither extreme is healthy.

Just beyond the range of  “average” or “normal” narcissism is something Stone labels “heightened self-regard,” which he accounts for as follows:  “In certain common life situations and various occupations, optimal performance seems to require a heightening of self-regard—or an exaggerated sense of indestructibility—that goes beyond the normal yet is adaptive to one’s circumstances . . . . [For example,] men with . . . ‘low harm avoidance’ and an exaggerated sense of invulnerability are those more likely, in wartime, to storm the enemy’s machine gun nest and to become heroes (dead or alive), preserving, if not their own lives, at least those of their comrades.”4  Stone also finds this level of heightened self-regard/self-confidence to be an intrinsic component of effective leaders.

Interestingly, some have observed that narcissism might be a "disorder" that only those in more developed countries have the luxury of indulging since in other parts of the world people are too busy taking care of meeting basic needs, such as food and shelter, to spend time on individualism.  In this respect, narcissists have been categorized as being at a more advanced level in Maslow's hierarchy of needs.  Millon and Davis point out that persons in cultures prizing "individualism and self- gratification at the expense of community"5—namely, the United States—would be more likely to develop narcissistic personality disorder.  Additionally, in such cultures, professions with high visibility that garner either "respect," such as law, medicine, or science; or those that carry the cachet of "stardom," such as sports, politics, and entertainment may also attract or foster the narcissist.

Perhaps one way to look at the difference between these non-pathological forms of narcissism and the pathological variety that expresses itself as Narcissistic Personality Disorder is the absence of enlightened self-interest in the pathological narcissism.  Enlightened self-interest can best be characterized as a frame of mind in which the person acts and thinks with regard to the needs of others, not from purely selfless reasons but rather because it is realized that by doing “good” for others the person can also derive positive gain for the self.  In contrast to this ability to also take into account the needs of others as well as one’s own, is the person with NPD, who is first and foremost self-directed.

Millon describes the personal style of the normal narcissistic person as being competitive and self-assured:  “An interpersonal boldness, stemming from a belief in themselves and their talents, characterizes these persons.  Competitive, ambitious, and self-assured, they naturally assume positions of leadership, act in a decisive and unwavering manner, and expect others to recognize their special qualities and cater to them.  Beyond being self-confident, they are audacious, clever, and persuasive, having sufficient charm to win others over to their own causes and purposes.  Problematic in this regard may be their lack of social reciprocity and their sense of entitlement—their assumption that what they wish for is their due.  On the other hand, their ambitions often succeed, and they typically prove to be effective leaders.”6

In contrast, pathological narcissism—Narcissistic Personality Disorder—is a state in which self-esteem is disturbed and regulated through a distorted self-structure with a pathological grandiose self which requires the individual to protect and boulster their self-esteem through maladaptive defensive means.7   It has been variously defined as, “‘activities aiming at maintaining cohesiveness and stbility of the self-representations’8 . . . ‘a concentration of psychological interest upon the self”9  . . . [and currently] ‘the libidinal investment of the self’10 [O. Kernberg, 1975].”11



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1APA, 2000
2Ronningstam, 1999
3Stone, 1998, p. 13
4Stone, 1998, pp. 14-15
5Millon & Davis, 1990, p. 273
6Millon, Blaney, & Davis, 1990, p. 32
7O. Kernberg, 1989, 1998
8Ronningstam, 1990, quoting Storolow, 1979, p. 674
9Ronningstam, 1990, quoting More & Fine, 1968, p. 674
10Ronningstam, 1990, quoting O, Kernberg, 1975, p. 674
11Ronningstam, 1990, p. 674