The American Psychiatric Association, based in Washington D.C., USA, publishes Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Text Revision (DSM-IV-TR) [2000] where it provides diagnostic criteria for Narcissistic Personality Disorder.

The DSM defines NPD as "an all-pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration or adulation and lack of empathy, usually beginning by early adulthood and present in various contexts."

The DSM specifies nine diagnostic criteria. For NPD to be diagnosed, five (or more) of these criteria must be met.

[In text below, I have proposed modifications to language of these criteria to incorporate current knowledge about this disorder. My modifications appear in bold italics.]

[My amendments do not constitute a part of text of DSM-IV-TR, nor is American Psychiatric Association (APA) associated with them in any way.]

[Click here to download a bibliography of studies and research regarding Narcissistic Personality Disorder (NPD) on which I based my proposed revisions.]

Proposed Amended Criteria for Narcissistic Personality Disorder

Feels grandiose and self-important (e.g., exaggerates accomplishments, talents, skills, contacts, and personality traits to point of lying, demands to be recognised as superior without commensurate achievements);

Is obsessed with fantasies of unlimited success, fame, fearsome power or omnipotence, unequalled brilliance (the cerebral narcissist), bodily beauty or sexual performance (the somatic narcissist), or ideal, everlasting, all-conquering love or passion;

Firmly convinced that he or she is unique and, being special, can only be understood by, should only be treated by, or associate with, other special or unique, or high-status people (or institutions);

Requires excessive admiration, adulation, attention and affirmation – or, failing that, wishes to be feared and to be notorious (Narcissistic Supply);

Feels entitled. Demands automatic and full compliance with his or her unreasonable expectations for special and favourable priority treatment;

Is "interpersonally exploitative", i.e., uses others to achieve his or her own ends;

Devoid of empathy. Is unable or unwilling to identify with, acknowledge, or accept feelings, needs, preferences, priorities, and choices of others;

Constantly envious of others and seeks to hurt or destroy objects of his or her frustration. Suffers from persecutory (paranoid) delusions as he or she believes that they feel same about him or her and are likely to act similarly;

Behaves arrogantly and haughtily. Feels superior, omnipotent, omniscient, invincible, immune, "above law", and omnipresent (magical thinking). Rages when frustrated, contradicted, or confronted by people he or she considers inferior to him or her and unworthy.

Sam Vaknin is the author of Malignant Self Love - Narcissism Revisited and After the Rain - How the West Lost the East. He is a columnist for Central Europe Review, PopMatters, and eBookWeb , a United Press International (UPI) Senior Business Correspondent, and the editor of mental health and Central East Europe categories in The Open Directory Bellaonline, and Suite101 .

Visit Sam's Web site at http://samvak.tripod.com

What if brain in vitro (in above example) could not communicate with us at all? Would we still think it is possessed of a self? The biological functions of people in coma are maintained. But do they have an identity, a self? If yes, why do we "pull plug" on them so often?

It would seem (as it did to Locke) that we accept that someone has a self-identity if: (a) He has same hardware as we do (notably, a brain) and (b) He communicates his humanly recognizable and comprehensible inner world to us and manipulates his environment. We accept that he has a given (i.e., same continuous) self-identity if (c) He shows consistent intentional (i.e., willed) patterns ("memory") in doing (b) for a long period of time.

It seems that we accept that we have a self-identity (i.e., we are self-conscious) if (a) We discern (usually through introspection) long term consistent intentional (i.e., willed) patterns ("memory") in our manipulation ("relating to") of our environment and (b) Others accept that we have a self-identity (Herbert Mead, Feuerbach).

Dan (probably) has same hardware as we do (a brain). He communicates his (humanly recognizable and comprehensible) inner world to us (which is how he manipulates us and his environment). Thus, Dan clearly has a self-identity. But he is inconsistent. His intentional (willed) patterns, his memory, are incompatible with those demonstrated by Dan before accident. Though he clearly is possessed of a self-identity, we cannot say that he has SAME self-identity he possessed before crash. In other words, we cannot say that he, indeed, is Dan.

Dan himself does not feel that he has a self-identity at all. He discerns intentional (willed) patterns in his manipulation of his environment but, due to his amnesia, he cannot tell if these are consistent, or long term. In other words, Dan has no memory. Moreover, others do not accept him as Dan (or have their doubts) because they have no memory of Dan as he is now.

Interim conclusion:

Having a memory is a necessary and sufficient condition for possessing a self-identity.

III. Repression

Yet, resorting to memory to define identity may appear to be a circular (even tautological) argument. When we postulate memory - don't we already presuppose existence of a "remembering agent" with an established self-identity?

Moreover, we keep talking about "discerning", "intentional", or "willed" patterns. But isn't a big part of our self (in form of unconscious, full of repressed memories) unavailable to us? Don't we develop defence mechanisms against repressed memories and fantasies, against unconscious content incongruent with our self-image? Even worse, this hidden, inaccessible, dynamically active part of our self is thought responsible for our recurrent discernible patterns of behaviour. The phenomenon of posthypnotic suggestion seems to indicate that this may be case. The existence of a self-identity is, therefore, determined through introspection (by oneself) and observation (by others) of merely conscious part of self.

Sam Vaknin is the author of Malignant Self Love - Narcissism Revisited and After the Rain - How the West Lost the East. He is a columnist for Central Europe Review, PopMatters, and eBookWeb , a United Press International (UPI) Senior Business Correspondent, and the editor of mental health and Central East Europe categories in The Open Directory Bellaonline, and Suite101 .

Visit Sam's Web site at http://samvak.tripod.com