healthy narcissism and npd, sperry

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¡i n dNARCISSISTIC PERSONAI^ITY DISORDELen Sperry, M.D., Ph.D . and Jon atha n J. Sperry, Ph.D .

ot only is narcissism aliveand well in America, but itbecame a major news event

this past year. Since the me-ism ofthe 1970s was analyzed in thebestseller, The Culture of Narcissism,dealing vsnth narcissism has preoccu pied

psychiatrists and other clinicians. Inthat book, historian Christopher Laschargued that Americans were becomingincreasingly self-preoccupied and nar-cissistic to the extent that pathologicalnarcissism was becoming normalizedand socially acceptable in Americanculture.

Lasch's impressionistic appraisalhas since been empirically supportedby various research studies. Forexample, national survey data from the

National Opinion Research Centerindicates that major shift in values tookplace in America in the late 1960s.Before that shift Americans valuedduty, hard work, a high work ethicand delayed gratification. After theshift these values began to be replacedby pleasure, a reduced work ethic andimmediate gratification. In a recentbook. The N arcissism Epidemic:Living in the Age of Entitlement, th epsychologist-authors recount otherresearch and chronicle social trends

that fuel wha t they call the relentlessrise of narcissism in our culture. Chiefamon g these trends are the self-esteemmovem ent and the move ment awayfrom comm unity-oriented thinkingand toward self-actualization andentitlement. Perhaps the most defming

trend they note is the shift that occurredin parenting, from limit-setting towardletting kids do and get whatever theywanted. These authors conclude thatthis changed attitude toward parentingsignificantly fueled the narcissismepidemic.

It may seem ironical that withinthis societal context, a major newsevent was that the DSM-V (theDiagnostic and Statistical Manual ofMental Disorders, Fifth Edition Work

Group on Personality Disorderswas considering eliminating the narcis-sistic personality disorder (NPD)from its much-awaited fifth edition.This article discusses the background ofthis decision, the ensuing controversy,and its likely implications. Beforethis discussion there is an extendeddescription of the dynamics of narcis-sism and the experience of narcissism,particularly in ministry. First, we beginwith an illustration to contextualize thediscussion.

THREE SEMINARIANS

Following are profiles of threseminarians in the midst of theitheology studies. Each represents a typof narcissism. A commentary on eachfollows the section on types o

narcissism.

SamSam is a second year seminarian a

a diocesan seminary. He is a topstudent and athlete with many friendand commands the respect of his peers,seminary faculty and administrationHe impresses others with his charmself-confidence, leadership abilitycommunication skills, interpersonaskills and sense of humor. He has been

heard joking with his friends that he hanot m et a mirror that he doe sn't like. Hknows he is quite gifted and admiredby many. Yet, despite his occasionabraggadocio, he is a sincere individuawhose priority is personal and spirituadevelopment. He is realistic about hipotential and believes he can and wilbecome an effective preacher andpastor. Nevertheless, at the prese nt timhis primary concern is learning as muchand growing as much as I can beforeordination.

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JerryJerry is a second year seminarian

who is an energetic, confident, andengaging individual who enjoys thelimelight. Because of his ability andgood looks he has become a studentleader in the seminary and was selectedas a regular cantor and an occasionalhomilist at seminary liturgies, bothremarkable distinctions since fourthyear students are usually assigned theseroles. He greatly enjoys his reputa tion asthe "alpha" male among his seminarypeers and envisions his priestly careeras a "rising star in the Church." He ishighly organized, detail-oriented andhighly effective. He insists he VÂW be acompelling présider and a beloveddiocesan official or pastor. On occa.sion,particularly when he is "on a roll" heboasts of "being appointed a bishop inthe not too distant future." Whenchallenged about how this might comeabout, his disdainfiil response is: "Howcan they keep this from me. Lookaround guys. I've got everything it takesand more '

Jeff is in the same year of studies as

Sam and Jerry. He, admires and is quitesolicitous toward Jerry, but is secretlyangry at and en vious of him. He sees hisfuture in the priesthood as a careertrajectory aimed at a top leadershipposition at the chancery or even in thediplomatic corps for the VaticanDep artm ent of State. Yet, he keeps thesecareer aspirations to himself Thosearound him would hardly suspect thesestrivings since Jeff has done little to cul-tivate relationships with key diocesanofficials or to establish a reputation as a"company man" like Jerry and otherseminarians who are hierarchy-bound.Instead, he comes across to others as acongenial, likeable, and unassumingseminarian who is loyal and can becounted upon to extend a helping hand.While he receives average grades hisinstructors suspect that he is under-achieving. He has been known to beratehimself and become self-reproachfulwhen crit icized-even mildly-by hispeers or faculty. Lately, his spiritualdirector has become increasingly con-cerned at Jeff s worried, guilt-ridden and

depressed manner, and puzzled becausethere is no obvious cause, such as a lossor failure.

TYPES OF NAR CISSISM

In everyday usage, the terms narcis-sism, narcissist, and narcissistic refer toindividuals whose ambitions, aspira-tions, or entitlement tend to be out ofproportion to their demonstrated tal-ents. Some narcissists are boastful andself-aggrandizing in public, while othersonly reveal their ambitions and entitle-ment to those closest to them. It isimportant to distinguish between indi-viduals who hold reaUstic self-assess-ments of their achievements and thosewith grandiose self-assessments.Healthy narcissists are more likely tomake realistic self assessments in con-trast to pathological narcissists whoseassessments are much more grandiose.This section describes four types of nar-cissism including healthy, covert, overtand malignant narcissism.

Healthy NarcissismHealthy narcissism can be

described as the capacity to love oneselfand to maturely love others. It requiresthe ability to distinguish reality from

fantasy, and the capacity to dem onstrateempathy and genuineness to others.Healthy narcissists possess an adequatesense of self-esteem which e nables the mto function effectively in the world aswell to .share in the emotional life ofothers. For Freud, good mental healthreflects th e capacities to b oth work welland to love well.

Freud contended that healthynarcissism is an essential part of normaldevelopment. He argued that adequate

parental love and caring results inmeeting the self-needs ofthat child Justas impor tant, the p arent s attitudetoward the child is understood as arevival and reproduction of their ownnarcissism. He believed that childrenexperience omnipo tence ofthought andthat parents stimulate and reinforcethat feeling because in their child theysee the things that they have neverfliUy achieved themselves. Accordingly,parents tend to overvalue the qualities

of their child. However, when parents

act in an extreme opposite manner anthe child is rejected or inconsistentreinforced, the self need s of th e chiare not met and pathological narcissisis likely to result.

orms of Pathological NarcissismJames F. Masterson, M.D., ha

described compelling portraits of twtypes of pathological narcissism, whihe calls the exhibitionist narcissist athe closet narcissist. Unlike the healtnarcissist, he describes the developm etal trajectory of both pathological typas the failure to adequately develop age- and ph ase- appro priate sense of seThe primary reason for this failure assumed to be a defect in the attachm estyle with the primary caregiver-usuathe mother-and the inabili ty of tcaregiver to provide adequate aconsistent psychological nurturance.

Overt NarcissismOvert narcissists, also called exhi

tionistic or classic narcissists, beliethey are better than others, continuaseek attention, lack emotionally warand caring relationships, seek statupower and possessions, and tend to overly concerned with their physiappearance. Overt narcissism is t

focus of the DSM-IV-TR (TeRevision) description and diagnoscriteria. It differs from other types narcissism in several important waThe overt narcissist is described having an inflated, grandiose sense self with little o r no consciou s awareneof the emptiness within, nor of temotional needs of others. Wliile thmay boast and exaggerate thimportance to others, inside thtypically experience a sense of insecur

and worthlessness. This experience inner emptiness requires the recurreinfusion of external confirmation their importance and value. As a resuthey constantly seek and demaconfirmation of their worth aspecialness. When they succeed receiving such confirmation in the foof status, admiration, wealth asuccess, they feel an internal elation.

They also behave in an overtgrandiose manner and tre

others-particularly those perceived

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lower in status-with contempt. Notsurprisingly they typically lack em pathyfor others. They typically feel depressedshamed and envious of those who suc-ceed in attaining what they lack. Theirlack of pleasu re in work or lov is painfulto witness. Furth erm ore when they feelrejected thwarted or frustrated they arelikely to act out their insecurities in out-bursts of anger called narcissistic rageverbal abuse and obnoxious behaviors.

These individuals spend consider-able energy evaluating themselvesagainst others and will defend theirwounded self-esteem through a combi-nation of idealizing and devaluingothers. When they idealize another theyfeel more special or imp ortant by virtueof their association with that person.When they devalue someone theyfeel supe rior. Not surprisingly theircolleagues and significant others tendto feel unreasonably idealized unrea-sonably devalued or simply disregardedby them.

overt NarcissismBy con trast covert narcissists also

called shy or closet narcissists are high-ly attentive to the needs of others. Infact they come across as hum ble andunassuming individuals who avoidbeing the cente r of attentio n. Still theyare exquisitely sensitive to criticism andslights from others and are likely torespond with harsh self-criticism. Likeovert narcissists covert narcissists havegrand iose fantasies feel a sense of enti-tlemen t and are exploitive but they arechara cterize d by worry ineffective fiinc-tioning and unfulfilled expectations.When they are overly stressed they arelikely to bec ome defensive hostile orself-reproachfiil. Because of intrapsy-chic dynamics their grandiose fantasies

are seldom if ever expressed in overtbehavior since these things are believedto be beyond their conscious attain-ment. Instead these individuals areconflicted and guilty over their exhibi-tionistic competitive and aggressivedesires which lead them to suppress orrepress any awareness of the existenceof these q ualities. Basically their severeinner conscience finds these fantasiesunacceptable and demands that theysuppress them and experience guilt As aresult they can attribute all goodness

and pow er to themselves bu t relegate allweakness and badness to others.

Like others who know them covertnarcissists tend to perceive themselvesas shy unassertive and inca pable ofachieving their dreams. Th e first hint oftheir underlying grandiosity appearswhen they realize that adolescent day-

dreams of being heroic and acclaimedhave persisted into adult life. Such fan-tasies and lack of achievement lead toincreased guilt continued attacks fromtheir conscience for not mee ting self-setstandards and feelings of worthlessness.Their inability to sustain ambitions orto pu rsue even attainable goals with fullded icatio n resu lts in significant self-pityfeelings of hurt and depression. If theyseek psychotherapy it is typicallybecause of depression and a sense ofinner deadness since nothing in lifematches the thrill of triumphantachievement that they imagine is duethem.

Despite believing that they deserveto be recognized for their specialnessthey are plagued by self-doubts and sodo no t seek the affirmation of oth ers forwhat they believe they are due.Moreov er they are unlikely to seek outappropriate friends or close intimaterelationships because they fear exposureas frauds. As a result they s urroun dthemselves with others whom theydeem conspicuously inferior to them-selves. W he n these ind ividua ls offerthem praise they discount this admira-tion as phony and insincere. Insteadthey rumina te abo ut how little their trueworth is appreciated and how oth ers getthe recognition for their achievementsand they procrastinate about accom-plishing achievable tasks because theyfear they will fail. As a consequencetheir demeanor is decidedly retiring

mo dest and shy. Unlike overt narcissistswho demand special attention from oth-ers in recognition of their superioritycovert n arcissists are mo re likely to fawnover others whose accomplishmentsthey envy while secretly harboringstrong feelings of resentment and con-tempt.

Though they experience guilt andshame for their ambitions or accom-plishmen ts they may still relentlesslypursue them without genuine regard for

others since the feelings of others are

Like overtnarcissistscovert narcissihave grandiosefantasies feela sense ofentitlementandare exploitivebut they arecharacterized b yworry ineffectifunctioning andunfulfilledexpectations.

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viewed as less important than theirs.Wliile they tend to hide their strivingsand accomplishments for fear of engen-dering envy in others, they know envywell. They suffer intensely fi'om it, evenas they fiercely disavow it. Because theyseldom show arrogance and aggression,they are seldom perceived by others as narcissistic even thou gh they manifestless obvious traits and the underlyingsense of vulnerability common to allnarcissists. Vulnerability refers to theirexaggerated reactivity. Commonly, nar-cissists react strongly to perceivedthreats to their self-esteem with intensefeehngs-overt or covert-of anger,envy, rage or harsh self-criticism, andmood variability such as irritabilityor depression, as well as avoidance andretaliatory or deceitful behavior. Theirattentiveness should not be taken foremp athy, for it is as difficult for th em toconne ct em otionally to others as it is forthe classic narcissist.

Malignant NarcissismA more pathological version of the

classic narcissist is the malignant narcissist.This type is only briefly n oted here sinceit is presumed to be uncommon inministry. Besides overt narcissisticfeatures, malignant narcissists alsoexhibit sadistic, paranoid and antisocialor psychopathic features. Like the overtnarcissist, they appear as self-sufficientand successRil, yet their inner experi-ence is tha t of being fragile, vulnerab le toshame and hypersensitive tocriticism. Failure to succeed in theirgrandiose endeavors is likely to result inprominent mood swings with feelingsof emptiness, irritability, rage, suspi-ciousness and sadistic aggression.Suspiciousness and sadistic aggressiontend to distinguish these individuals

from overt narcissists. Furthermore,when these individuals are not involvedin narcissistic pursuits, they tend to becold, unempathic, exploitative andindifi^rent toward others.

NARCISSISM AND THE THREESEMINARIANS

The reader may have alreadyidentified the type or pattern ofnarcissism for each of fhe three

seminarians. Comparing their profiles

to the four types of narcissism, Sammatches the healthy narcissistic type.Jerry clearly matches the overt pattern,while Jeft match es the covert narcissisticpattern.

Clinical psychologists whoevaluate candidates for admission todiocesan seminaries and religious ordersfind that a narcissistic patternis relatively common among suchapplicants.

Generally, the healthy narcissisticpattern is a better fit with ministry thanthe pathological types or patterns ofnarcissism. Unfortunately, becauseclinical practice in America is signifi-cantly influenced by DSM diagnosticcriteria, only the overt type of thenarcissistic personality is likely to beidentified and diagnosed. That meansthat the covert pattern of the narcissi.sticpersonality is unlikely to be identifiedand diagnosed. Among other things,it means that such individuals oftendo not receive the kind of psychothera-peutic help that could reduce theirsuffering and increase their ministerialeffectiveness and well-being.

DSM vs . PDMThe Psychodynamic iagnostic

Manual (PD M ) was recently developed

as a complement to the iagnostic an dStatistical Man ual of Men tal isorders(DSM). PDM describes both healthyand disordered personalities andsymptom patterns. In addition, itprovides profiles of mental functioningthat include patterns of relating,comprehending and expressingfeelings. Unlike the DSM which focusesexclusively on external behavior andseeks to answer the question: Wliat islikely to be observed for a specific

mental health disorder? the PDMfocuses primarily on internalexperience, and seeks to answer thequestion : What is it like to experience aspecific me ntal health d isorder?

Diagnostically, DSM-IV-TR speci-fies nine behavioral criteria, (i.e., has agrandiose sense of self-importance; ispreoccupied with fantasies of unlimitedsuccess; believes they are special andunique; requires excessive admiration;has a sense of entitlement; is interper-

sonally exploitative; lacks empathy; is

envious and shows arrogance) of whifive are need ed to m ake the diagnosisNarcissistic Personality Disorder. contrast, fhe PDM indicates fhat tpathogenic belief about self for the ncissistic person ality disord er is: I neto be perfect to feel okay. The charateristic pathoge nic belief about o thers Othe rs enjoy riches, beauty, power afame; the more I have of those, the bter 1 will feel.

Unlike the DSM, the PDM can of considerable clinical value autility to clinical psychologists aothers evaluating candidates for tpriesthood , religious life and othe r mistries. In addition to clearly and sucinctly describing the intrapsychdynamics of the narcissistic personaldisorder and providing treatmeconsiderations, it recognizes bothe overt and the covert types narcissistic personality disord ers.

THE EXPERIENCE OFNARCISSISM IN MINISTRY

Ministry provides a ready-maforum to reinforce and reconfirm grandiose self For the overt and covnarcissist, the theological formulationvocation as a call from G od, a sign be ing set apart, confirms the ir belietheir inherent specialness and superioty over others. For those vWth pubministries such as presiders ahomilists, liturgies and other religioservices are viewed as a forum exhibit that special call. Even thouthey would publicly deny it, they msecretly harbor the behef that treal purpose of a religious service worship of themselves. Accordinghtuigies are primarily a performanwhere the worshiping congregati mirrors , i.e., admires and praises minister.

Because of their self-absorptiand self-deceiving tend encies, patholically narcissistic ministers mcreatively distort the precept to loGod and neighbor to fit thpathological perspective. For theGod, and everyone else exists for opurpose: to love and take care of theTheir basic spiritual deficit is a lack

awareness of grace and an incapacity

VOLUME 32 NUMBER FOUR WINTER 2 11



gratitude . No t surprisingly theyimagine G od as an all-giving father and

they perceive faith as magicalentreaty. Con seque ntly they believeGod will do exactly as they ask in theirprayers with no regard to the kind ofclaim God has on them. For themthere is only one kind of prayer: theprayer of petition or demand. Prayer aspraise self-examination forgiveness orthanksgiving has little meaning forthem. Some narcissistic ministersmay have intense mystical leaningsthat pull them in the direction of

mystical experience including theoccult. This is understandable in lightof their sense of specialness andgrandiosity. However they are morelikely to experience an exaggeratedstate of self-exaltation than a truemystical state. When prayers are notanswered as they expect they becomenarcissistically wounded and feel deeplyrejected. As a result they m ay rejectGod becoming an atheist for aninstant or forever because Go d has let

them down.

The overt narcissistic minister istypically insensitive to the suffering

and needs of others. While they mayoffer to help others in need and engagein acts of charity they will do theseonly if their charitable deeds arenoticed by others. If their efforts do notbring attention to them they areunlikely to make a dona tion extend ahelping hand lend a listening ear orcontinue these actions when theattention and praise of others stops.These ministers have learned the art ofmanipulation and will on occasion act

opportunistically. While they maycome across as lacking in warmth andconsid eration their sense of innerdirection allows them to inspireothers and create a common causetranscending petty self-interests.Nevertheless exploitation and coercionare features of overt and malignantnarcissism. These features are notuncommon in sexual misconductinvolving ministers with narcissisticpersonality disorders particularly with

the malignant pattern.

It should also be noted that whilhealthy narcissistic ministers can b

ambitious manipulative and sensitivto criticism they typically posse ssufficient self-confidence adaptabilitand humor to be effective in ministeriasettings and interpersonal challengeSince they are not pathological opersonality-disordered it is much lesunlikely that healthy narcissists wicreate the havoc in their ministries thais the hallmark of the overt the coveand the malignant narcissists.

Narcissism and lericalismIt would be remiss not to mentio

clerical culture and clericalism whediscussing narcissism in ministry. Threason is that a priests identityattitudes and behaviors are influenceby culture including the clericaculture in which they functionClerical culture reflects values associaed with privilege e ntitleme nt separatness and status values consistent witnarcissism. Clericalism is the extrem

and some would say pathologica

HUMAN DEVELOPMENT



version of clerical culture, and isinconsistent with healthy priestlyministry (Conference of MajorSuperiors of Men, 1983). A priestsindividual dynamics continuallyinteract with the organizationaldynamics of diocese or religious com-munity. That interaction-called fit -can either foster growth orregression and psychopathology in thepriest. In other words, priests with a good fit betwee n their healthy corevalues and a diocese's healthy corevalues are more likely to experiencep.sychological and spiritual health and

well-being than if there is a poo r fit.Thus, a diocese with healthy corevalues is likely to foster neutral orpositive growth in priests with healthynarcissism, while a diocese thatreflects the values of clericalism ismore likely to limit positive growth andeven reinforce existing pathologicalnarcissism. For this reason, somewould argue, individual dynamics ofpathological narcissism is a relativecontraindication for ordination to

priestly ministry.

Narcissistic Personality Disorder andDSM V

A November 29, 2010 New York

Times article reported that the DSMPersonality Disorders Work Group wasconsidering dropping the narcissisticpersonality disorder from DSM-V.This disclosure has since engenderedconsiderable and w idespread discussionabout narcissism. While many agreethat it should be dropped because ofsignificant problems with researchfindings, other s have offered com pellingevidence in favor of keeping NPD asa personality disorder. Several

suggestions have been made to retainthe disorder in DSM-V. Clinicians,patients and researchers have expressedstrong, albeit different, reactions to theDSM Personality Disorders WorkGroup's decision.

Overall, clinicians and patientsfavoring elimination of the disorderhave identified serious problems withthe current conceptualization of NPD.In particular, they fault DSM-IV'semphasis on the covert type of

pathological narcissism with its focus

on grandiosity and external, sociaand interpersonally conspicuobehavior. This has resulted in conside

able discrepancy between the cUniciaview and usage of the NPD diagnocompared to its official diagnostcriteria. Not surprisingly, theclinicians are reluctant to use tdiagnosis and some patients strongopp ose being labeled NP D, viev iit as prejudicial.

The concerns of researchers difffrom clinicians and patients. Chiamong these concerns are issues validity and limitations in the descri

tion and criteria for the disordeCriteria for any disorder must havehigh degree of discriminant validitwhich is the extent to which the critercan identify one construct withodisplaying a high correlation with less similar construct. Findings on tDSM-IV criteria for NPD displayinconsistent results. In addition, survey study of nearly 35,000 adufound that N PD was inversely related age, with the largest decline occurrinafter age 29. The implication is th

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NPD is a disorder of adolescenceand young adulthood that seems todisappear before midlife. Th is is

problematic because by definition apersonality disorder is a life-long patter nof maladaptive behavior.

Two key concerns with the currentdescription and criteria of the DSM-IV

a r e : l) its view of NP D has anoveremphasis or one-sided emphasis onthe dimension of grandiosity and 2) itunderemphasizes the dimension ofvulnerability. While all pathologicalnarcissists present with grandiosity,DSM-IV emphasizes the externallyfocused grandiose self-view,exceptionally high aspirations andself-centeredness of the overtnarcissist. However, it does not includethe internal experience of having

fantasies and ambitions that areunfulfilled which are m ore characteristicof the covert narcissist. As a result,those presenting with covert narcissisticfeatures are unlikely to be diagnosedas NPD .

The current under-emphasis andunder-recognition of vulnerability isalso problematic. Experienced clinicianshave long recognized that all three t)'pesof pathological narcissists experiencevariable and vulnerable self-esteem

which alternates between overconfi-dence and inferiority. They tend to behypersensitive to relatively minorcriticism or questioning of their wordsor actions, and will react quickly wnthangry outbursts, hurt feelings or evenphysical symptom s. Often, p athologicalnarcissists project their suffering andinsecurities onto others throughvarious kinds of acting out. Ye t DSM-IVhas no criteria for vu lnerability.

On e researcher, Elsa Ronningstam,

Ph.D., of Harvard Medical School hasproposed a revised set of diagnosticcriteria for DSM-V, that addresses manyof the limitations of the descriptionand criteria of NPD in DSM-IV. Shebroadened the definition of grandiosityand reformulated the characteristics andcriteria of grand iosity as it differs am ongthe overt, covert, and malignant types.She also adds th e criteria of vulnerabilityas central to understanding thisdisorder. Presumably, such reformulated

criteria will increase the validity of the

disorder and reflect the life-long patternof dysfunctionality that defines apersonality disorder. Interestingly,these suggested criteria seem to notonly better reflect clinical practice butalso are consistent with the PDMdescription of N P D .

C O N C L U D I N G C O M M E N T S

There is no doubt that narcissisminfluences American culture. For themost part this influence has beennegative. The diagnosis of narcissisticpersonality disorder came into beingjust as narcissism and immediategratification overtook duty and delayedgratification as cultural values inAinerica. Unfortunately, there aresignificant problems with current DSM

diagnostic criteria for the narcissisticpersonality disorder. Among them isthe narrow focus on grandiosity andunder-emphasis of the more generalcriterion of vulnerability. While the fateof NP D in DSM -V remains uncertain asof the summer of 2011, the preferredcourse of action m ay be a refinement ofthe narcissistic personality disordercriteria rather than the wholesaleelimination of the disorder itself Evenif it is formally eliminated, clinicians

could still assess narcissistic traits, andcould offer psychotherapy focused onfacilitating healthier narcissism. Whenit comes to the church, there is noquestion that pathological narcissism isincompatible with effective Christianministry. Accordingly, those chargedwith screening candidates for thepriesthood, religious life and otherChurch ministries would do well toassess candidates for pathologicalnarcissism in all its guises, including

overt, covert and malignant narcissism.

RECOMMENDED READING

Conference of Major Superiors of Men(1983) . In So lidarity and Service:Reflections o n t h e Problem of lericalism inth e Church. Washington, DC : Author.

Cooper, A.M. (199 8). FurtherDevelopm ents in the Clinical D iagnosisof Narcissistic Personality Disorder. In

E. F. Ronningstam (Ed.), Disorders of

Narcissi.^m: Diagnostic, Clinical andEmpirical Implications (53-74)Washington, DC: American PsychiatrPress.

Lasch, C. (1979/1991). 77if ulture oNarcissism. N ew York WW Norton

Masterson, J .

( 1993). T he Emerging SelfA Developmental Self ó Object RelationApproach to the Treatment o/ the loseNarcissistic Disorder of the Self NewYork: Bru nner/Mazel.

Ronning stam. E. (20 11 ). NarcissistPersonality Disorder in DSM V: ISupport of Retaining a SignificaDiagnosis. Journal of PersonalityDisorders, 25, 248-259.

Twenge. J .

and W. K. Campbell (20 10Th e Narcissism Epidemic: Eiving in t g e oJ Entitlement New York Free Press

L e n S p e r r yM.D.P h . D .is p r o f e s s o ofm e n t a l h e a l th c o u n sin g at F lor ida A tU n i v e r s i t y a n d p r o f e s s o r o f p s ya n d b e h a v i o r a l c i n e at the M e d iCol lege of Wi s c o nI l_ I _. L I- 1

w i d e l y i n t h e a op s y c h o l o g y s p i ra n d m i n i s t r y a n d hc o n s u l t e d w i t hd i o c e s e s a n d r eo r d e r s .

J o n a t h a n S p e r ryis a s t a f f t h e r a p at h e c o u n s e l i n g andp s y c h o l o g i c a l sc e n t e r of F l o rA t l a n t i c U n i v e ra l s o h a s c o n s i de x p e r i e n c e ww i t h s p i r i t u a l ac h o l o g i c a l i s s u op e o p l e l i v i n g H I V / A I D S .



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