Rahul, a 30-year-old male came for psychotherapy with complaints of recurrent depression, addiction to alcohol, relationship instability, obsession with work and bodily pain without any known medical cause. After taking a detailed diagnostic personality test, it was figured out that he was suffering from narcissistic personality disorder (NPD). He expected to be at the centre of attention everywhere and receive unlimited praise and importance. As this was quite impossible he frequently felt depressed and angry. His marriage was breaking apart as his wife thought that he was selfish, brutal and cold. He expected her to automatically understand his feelings and function as per his wishes. It was hard for him to tolerate even minor digressions. He flew into rage and became violent with her. He thought that he was far too superior to her and she should submit herself to his will completely. At work as well, Rahul had a patronizing and envious attitude towards his co-workers and bosses. He felt that he deserved to lead the company and everyone else's intelligence was inferior to his. In short, narcissistic personality disorder was creating chaos in all spheres of his life but he had little insight into it.

In India, although narcissists can be found in all professions, a majority of narcissists are attracted to professions that promise limelight. This includes politics, film industry, social media, healthcare, modelling, real estate, cricket and business. These people will do anything to be a part of page 3.

One needs to understand that some degree of self-love, a need to be admired by others and self-absorption is healthy as it leads to development of a strong self. However, a preoccupation with oneself along with a disregard for needs and wishes of other people becomes traumatic for the person as well as those dealing with them.

Symptoms of Narcissistic Personality Disorder
Following is a list of common signs, traits and symptoms of narcissistic personality disorder:

. Superiority Complex: Individuals with narcissistic personality disorder overestimate their abilities and inflate their accomplishments appearing boastful. They harbour an illusion that they are special. They underestimate and devalue others. They feel that they can be understood by and should associate with special people. They often daydream about unlimited power, brilliance, beauty or ideal love.

. Green with Envy: An important trait that characterizes narcissistic personality disorder is envy. They are often envious of others and believe that others are jealous of them. They often resent successful and resourceful people, feeling that they deserve those accomplishments, admiration or privileges better than anyone else.

. Admiration Hunger: Deep down narcissistic personalities suffer from low self-esteem and have a hunger to be constantly admired and praised by others. They expect to be catered to and are enraged when this does not happen. As a result they often have a need to be in the limelight. Their sense of self is dependent upon affirmation and tributes from other people.

. Lack of Sensitivity: Individuals suffering from narcissistic personality disorder expect to be given whatever they want and use other people as rag dolls. They feel a sense of entitlement that their needs and wishes should be given priority over everyone else.

. Troubled Relationships: While deep down, an individual with narcissistic personality disorder longs for a good reciprocal relationship, they are scared of being traumatized in the process and therefore erect barriers. Thus, they make multiple shallow relationships and treat other people as 'need-satisfying objects' to be used when needed and thrown away when done away with. They are prone to have multiple romantic and sexual partners without allowing themselves to feel genuine and deep love.

. Divided Self: The narcissist has two contrasting selves, the idealized self and the devalued self. The idealized self feels very powerful, important and top-of-the-world while the devalued self feels inferior, fragile and ugly. Their experience of self is chaotic as it shifts from one extreme to another; either they see themselves as superhuman or subhuman with no real middle ground.

. Inner Void: Narcissistic personalities feel empty from inside and seek external admiration to fill this void. As long as they get it life seems to be blissful and they feel powerful. The moment this gets compromised, even for a minute duration the narcissist slips into depression, envy and rage. They feel very scared while experiencing this emptiness and often distract their mind by being workaholics, promiscuous and drug-addicts.

. Superficial Thinking: A commonly seen trait in narcissistic personality disorder is 'headline intelligence.' These people appear to be full of interesting ideas, thoughts and impressive plans but when it comes to putting these into action they fail miserably. This is so because they shy away from deep engagement with anything and are just capable of creating a superficial impression to attract others.

Narcissistic Personality Disorder Relationships

While people are easily attracted to a person with narcissistic personality disorder due to the outside 'glitter', problems intensify as the relationship develops. Narcissistic people search for an 'ideal mate' who is far removed from the reality. They are blind to desires, subjective experiences and feelings of other people. They like to use and throw people as need satisfying objects. Whenever they find that the person digresses even a bit from their ideal they get disappointed and enraged. They tend to inflict a similar pain onto the partner and the relationship starts cracking. People who are in a relationship with individuals suffering from narcissistic personality disorder need to understand that this is due to a traumatic past. They are able to deal with the narcissistic person better once they develop deep insight into the psychodynamics of the relationship along with effective communication skills.

Understanding the core

The common sense and lay understanding of the term 'narcissistic' conjures the image of a person who is full of vanity and callousness towards others. While this popular view can be easily seen at the surface in observable behaviour of almost every narcissistic personality disorder case, the core tells a rather different story, a story of trauma.

People with narcissistic personality disorder have a history of severe childhood trauma. Behind every boastful narcissist, there exists a self-conscious, weak and shame-faced child. Narcissist people have had traumatic experiences in their life where they were loved and cared for, not because of what they really were but because of the function they fulfilled. The pressure that one will be valued only if one exists in a certain way makes the person feel that their true self is horrible. As a result, the person develops narcissistic personality disorder- deep down they feel like dirt and their entire life is organized around constantly fighting this feeling by accumulating evidence to contrary.

Narcissistic Personality Disorder Treatment

Although narcissistic personality disorder is commonly seen in psychiatric patients in India, very few mental health professionals have the expertise to diagnose and treat it. Usually, psychiatrists and psychologists focus on the symptom patterns that a narcissistic person presents with including depression, addiction and adjustment problems. Also, treatment of symptoms brings some relief, it is often temporary. For lasting relief, the personality disorder needs to be diagnosed and treated. While traditionally narcissistic personality disorder was considered untreatable, advances in psychoanalysis led to development of effective treatment. Components of treatment for narcissistic personality disorder include:

. Empathic understanding: It is a process where their psychological needs are given priority for a long while in order to develop a strong self and shift focus from self to others. It requires suspending one's own point of view and seeing the narcissist from his/her own point of view.

. Developing self-esteem: Narcissistic people are constantly battling low self-esteem and try to compensate by running after achievements. Mirroring who they really are strengthens their self-esteem and makes them realize the value of other person.

. Fulfilling self-object needs: A narcissistic personality has unfulfilled childhood needs that need to be catered to by the processes of mirroring, idealization and twinship.