In depth study on narcissistic personality disorder

This research paper will explore a particular personality disorder called narcissistic. Definition, causes, characteristics, role of childhood, development theory, self-destructive behavior, treatment (therapy & drugs). The major issues in this term project were: discovering the effects of Narcissistic Personality Disorder on casual attributions (examining the attributional style of individuals with Narcissistic Personality Disorder), examining whether or not narcissistic individuals display more day to day variability and extremity in their emotions than less narcissistic individuals, if there are differences in self-conceptions between narcissists and other individuals that mediate or moderate such affective reactivity, if this emotional reactivity is related to general mood or to more specific self-related affect, and if these affective reactions are linked to specific kinds of events

The purpose of this paper is to discuss the general characteristics and treatment of Narcissistic Personality Disorder (NPD). The paper begins with some historical information regarding the condition. Diagnostic criteria and prevalence rates are also provided. This is followed by a brief review of counseling and therapy strategies and techniques for treating NPD.

A personality disorder is an enduring patter of inner experience and behavior that deviates markedly from the expectations of the individual;s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stalbe over tiem, and leads to distress or impairment (pg. 685 DSM). There are currently ten personality disorders recognized by the DSM, and this paper will discuss narcissistic personality disorder. People often confuse narcissistic as being full of one’s self, but it has a more complex side. It will present a review of the literature on borderline personality disorder, a treatment plan for a patient with the disorder, and discuss the therapeutic alliance between a patient with borderline personality disorder and his/her therapist. An estimate of the prevalence of personality disorders in a community population is from two percent to 14 percent (Linehan Oldham, & Silk, 1995; Hubbard, Saathoff, Bernardo, & Barnett, 1995; Coreeli, 1998).

Development of Narcissistic

A narcissitic person thinks the world revolves around them. They are inconsiderate people who are not kind. Another word for narcissim is a conceited selfish person. The word narcissim was coined by Sigmund Freud. There is a Greek myth about a man Narcissus. He was very self-absorbed and fell in love with his own reflection in water.

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Narcissistic Personality Disorder (NPD) bases itself on the personality trait of narcissism. According to the Mayo Clinic, NPD is a mental disorder in which people have an inflated sense of their own importance and a deep need for admiration. People who suffer from NPD believe that everyone is inferior to them and do not care about other people’s feelings. They require constant attention and exaggerate their achievements and talents; however, even though people who have NPD appear to be very conceited and self-absorbed, they do not handle criticism very well. They are very vulnerable to it and react to it with fury and embarrassment.

As stated in lecture, people with severe personality disorders are at high risk for hypochondriasis, alcohol and drug abuse, and violent and self destructive behavior. The three main symptoms of NPD stated in the video are: “the narcissist has grandiose fantasies with an exaggeration of accomplishments and their place in the world,” “extreme selfishness and self-centeredness with lack of empathy for others and a sense of entitlement,” and “overly sensitive to criticism or any challenge to their false self-image.” They do not care what they do, as long as they are benefitted. They do not connect their actions with consequences. They believe that they can do whatever they want and no one can tell them otherwise. This fact may serve as a motivation to commit crime. If the law says a person cannot do something, the narcissist believes it does not apply to him/her.

Criteria for Narcissistic Personality Disorder

Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high status people (or institutions)

Requires excessive admiration

Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations

Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends

Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others

Is often envious of others or believes that others are envious of him or her

Shows arrogant, haughty behaviors or attitudes

Causes of Narcissism

Medical data showing early mistreatment of individuals from physical, sexual, or emotional have negative effects on brain development. Brain wave abnormalities were present in histories of such early traumas and were at twice the rate compared to non-abused patients. The left side of EEG also showed abnormalities and diminishing development of the left hemisphere. The MRI showed the left hippocampus of abused patients was much smaller compared to non-abused. Studies also showed, that abused children showed deficits of verbal memory. These alterations can increase the risk of depression and many other disorders, including Narcissistic Personality Disorder.         

Investigations on verbal abuse also show increase risks for personality disorders. Offspring who experienced maternal verbal abuse were three times more likely to have borderline, narcissist, obsessive compulsive, and paranoid personality disorders, during adolescence or early adulthood. These associations remained significant. Also which showed the disorders to be elevated in adulthood.

There may be a link, between Obsessive Compulsive Disorders and Narcissist Disorders. Thus being a superficial function, to hold on to the self-object. Causing loss of the bond would experience loss of self.

ADHD may also be associated with the narcissistic disorder. Children who suffer from ADHD are unlikely to develop the attachment necessary. Thus the narcissistic disorder occurs, due to regression or adaptation. Another hypothesis could be the linkage of autistic disorders to Narcissism.

Treatment

Most narcissists reject the idea they are mentally disturbed. The level or degree of Narcissism can improve, but rarely will an individual suffering from the disease be cured because of the life long, irreplaceable and indispensable emotional investment in their disorder. Narcissists are attached to one thing their disorder.

Treatment of narcissist revolves around the transference of relationship. The analyst remains silent and invisible, there to listen, echo and interpret the actions of the Narcissist. The therapist remains emphatic to the needs of his patient by becoming a mirror for the Narcissistic to confront his or her alter ego. According to Grunberger, “the patient should enjoy complete narcissistic freedom in the sense that he should always be the only active party. The analyst has no real existence of his own in relation to the analyzed,” the analyst does not have to be good or bad or even exist at all. Analysis is not dialogue; it is a monologue for two voices, one speaking and the other echoing, repeating, clarifying, and interpreting correctly. According to Grunberger, the analyst has to remain a faithful and untarnished mirror.

Once the therapeutic relationship is established, the narcissist mirror transference and self-object transference emerge. This will only happen when the therapist can provide a strong sense of validation to the narcissist allowing the narcissist to recall his injured child. The level of reflecting back to the injured child will depend on the three types mentioned previously. The merger transference will perceive the therapist to be a virtual extension of them. If the therapist should slightly vary from the needs or opinions of the narcissist, the patient will respond by withdrawing. Under the second type, the narcissist perceives the therapist to be separate but alike. It is necessary that the narcissist view the therapist as just like me and be maintained. The third type the therapist must be able to bolster the narcissist’s insecure self. Thus the only interest in the narcissist is to reflect his or her grandiosity.

Utilizing the transference enables the narcissist to heal his or her low self-esteem and restate the damaged grandiosity. To heal the false self, the therapist must take advantage of the narcissist’s emotional state. Making the narcissist focus toward his or her inner feelings at that time. Another approach could be hands-off type. By letting the narcissist take control of the sessions in therapy. It is up to the therapist to recognize the narcissist injury and discover the cause of injury. Once the injury is discovered the therapist must explore the issue with out threatening the narcissist.

NPD in the DSM-V

Christian Perspective

A Brief History of Narcissism

In 1898, Ellis first used the term narcissism in relation to psychology phenomena when he describe a special state of auto-erotism in which sexual feelings become absorbed in self admiration. Freud later incorporated the term into his psychoanalytic theory in his 1914 essay ‘On Narcissism’. Freud considered narcissism a sexual perversion involving a pathological sexual love of one’s own body. These two theories cite developmental problems in childhood as causal factors leading to the development of Narcissistic disorder, while others suggest that society as a whole causes the disorder. Since then several other psychological theories have attempted to explain and treat the disorder. However, the psychodynamic perspective of Narcissism offers the most comprehensive explanation of the disorder.

The Psychodynamic View of Narcissism

Two overlapping schools of thought dominate the psychodynamic model of Narcissism: the self-psychology school represented by Kohut and the object relations’ school represented by Kernberg. Kohut suggests narcissism is a component of everyone’s psyche that we are born with the disorder. Kernberg argues that narcissism represents a fixation in ones of the developmental periods of childhood.

The Self Psychology School

Heinz Kohut believed that narcissism was a natural and normal development from birth to adult. In which a healthy normal person, would be able to transform his or her infant narcissism into adult narcissism. “Transmuting internalization” is a term he used to describe the process in which an infant transforming into an adult would encounter various challenges resulting into some frustration. Having optimal frustrations leads the person to develop a strong internal structure or a strong sense of ones self. This is used to compensate for the lack of external structure or support from others, thus if the narcissist process of transmuting is obstructed. Due to a level of frustration that exceeds the optimal frustration, in which the person experiences. He or she will be stuck in the infantile level, displaying many characteristics of omnipotent and invulnerable child.

The Objects Relations School

Otto Kernberg’s views of narcissism are based on Mahler’s theory of separation. Consisting of an individual process of separation, from infancy to early childhood. The developing child gains a stable self-concept by mastering two major phases, normal autism and symbiosis, along with four other sub phases: differentiation, practicing, rapprochement, and consolidation of separation-individuation. Kernberg argues that an individual is unable to successfully master the rapprochement sub phase and becomes fixed at this level. At age 10 to 14 months begins the development stage, in which the child learns to walk. This ability, gives a whole new perspective for the child thus giving a sense of grandiosity and omnipotence, which resembles a narcissist behavior. At age 14 to 24 months the child enters in the rapprochement sub phase finding that he or she has limits of what he or she can do. If the child is severely frustrated they adapt by refusing or consequently returning to the practicing sub phase. This will be his or her security omnipotence and invulnerability.

The Development of Problems

The development of problems occurs when narcissistic traits become exaggerated in an individual’s personality. During the first eighteen months of life an infant is provided with narcissistic defences. The infant is able to experience being the center of their mother’s world and an oneness with the mother develops. Being the center of the mother’s world makes the child feel powerful and omnipotent and they know no limits to their world. However, a psychological transformation near the end of the eighteen-month period causes the disintegration of the child’s oneness with the mother to take place. When this separation period begins the experiences of the child determines the development of the ego and the onset of NPD. These experiences encompass the mother’s ability to be responsive and sensitive to the needs of the child during the first eighteen months. Also, significant in the develop of the ego is the limits and consequences the parents provide between two and ten and the amount of abuse or trauma the child receives during the first seven years of life. This abuse does not necessarily have to come from trauma induced by parents. Authority figures or peers can also be the culprits. A pattern of grandiosity, excessive need for admiration, entitlement, and lack of empathy are the chief components in the diagnosis of NPD. These behaviours begin in early adulthood. A narcissistic individual is unable to trust, relies on others, and thus develops numerous, superficial relationships to extract tributes from others. Because a narcissistic individual has a changing morality–always ready to shift values to gain favour –any relationship with a narcissist has difficulty. Their tendency is to form friendships or romantic relationships with only those that can enhance their self-esteem or advance their purposes. A narcissistic individual has a basic sense of inferiority. Under this inferiority is a preoccupation with fantasies of outstanding achievement and an aimless orientation toward superficial interests. The narcissist uses others to aid them in any tasks they assume and will frequently take credit for work which others have done. The narcissistic individual may be more successful at their chosen field of work than some of the other personality disorders because their narcissism is advantageous in their employment especially if their work provides narcissistic supply. However, typically they are never able to direct their interests long enough to completely develop any long-term projects and if these projects are completed they may not be of the highest quality.

Narcissists will over inflate their own accomplishments, are boastful, and pretentious. Although he or she may impress others with knowledge and decisiveness, a narcissistic person’s information base is often limited to trivia. Lying is an essential parts of the narcissist’s behaviour and all their self-reports are unreliable. Their cognition is impaired to the extent that they frequently misconstrue other’s speech and actions. They may actually believe that someone respects or loves them although this is a fantasy which exists only in the mind of the narcissist. Their ideas are seldom original and they choose to quote whoever at that time they feel is an authority. The narcissist’s quotations may not be accurate to what the chosen authority at the time meant. People other than the narcissist may wonder why the narcissist picked that individual as an authority because no true validation may exist that the person the narcissist picks is an authority. They expect special treatment from others such as not waiting in line or being the center of attention and are mystified when they do no get what they want. They expect to get whatever they want no matter what it means to others. They also feel that they can only be understood by people of high status and they often assign special, gifted, or unique qualities that are not factual to the people with whom they associate. They will insist that they have the best doctor, lawyer, etc., available, and will assign accomplishments to that individual to prove their validity. If an individual disappoints them, however, then they frequently will negate the credentials of those that disappoint them. A narcissistic individual has a fragile sense of self. To strengthen their sense of self they depend on other’s admiration and constant attention. They expect other’s to covet their possessions and they are constantly seeking compliments. A narcissistic injury occurs when someone defeats or criticizes the narcissistic individual. The narcissist may not show it outwardly, but they are haunted by criticisms and defeats. They begin to feel empty, degraded, and humiliated and are capable of retaliating with narcissistic rage. Their reactions constitute contempt or defiant attacks.

The purpose of this paper is to discuss the general characteristics and treatment of Narcissistic Personality Disorder (NPD). The paper begins with some historical information regarding the condition. Diagnostic criteria and prevalence rates are also provided. This is followed by a brief review of counseling and therapy strategies and techniques for treating NPD.

NPD: History, Diagnostic Criteria and Prevalence

According to Pervin (1990), the origins of psychological thought regarding NPD can be found in Freud’s early writings on narcissism. In this regard, Pervin states that Freud characterized narcissism in five ways. These were as: (1) a sexual perversion in which one’s own body was used as a sexual object; (2) a stage of libido development; (3) a type of object choice in which the sexual object is chosen because of having characteristics similar to one’s own; (4) a type of object-relationship in which libidinal cathexis is withdrawn from external objects and redirected toward the self or parts of self; and (5) a constituent of self-esteem related to the ego ideal.

The Narcissist’s View of Others

Just as the individual becomes narcissistic because that is what the environment

‘needed’ him or her to be, so does the narcissist view others not as they are, but as what

he or she needs them to be. Others are thus perceived to exist only in relation to the

narcissist’s needs. The term object relations thus takes on a special meaning with the

narcissist. “We are objects to him, and to the extent that we are narcissistic, others

are objects to us. He doesn’t really see and hear and feel who we are and, to the extent

that we are narcissistic, we do not really see and hear and feel the true presence of others.

They, we, are objects… I am not real. You are not real. You are an object to me. I am

an object to you” (Johnson, 1987; P. 48). It is apparent than that the narcissist maintains

the infantile illusion of being merged to the object. At a psychological level he or she

experiences difficulties in differentiating the self from others. It is the extent of this

inability to distinguish personal boundaries which determines the severity of the

narcissistic disorder (Johnson, 1987).

Levels of Narcissism

The most extreme form of narcissism involves the perception that no separation exists

between the self and the object. The object is viewed as an extension of the self, in the

sense that the narcissist considers others to be a merged part of him or her. Usually, the

objects which the narcissist chooses to merge with represent that aspect of the narcissist’s

personality about which feelings of inferiority are perceived. For instance if a narcissist

feels unattractive he or she will seek to merge with someone who is perceived by the

narcissist to be attractive. At a slightly higher level exists the narcissist who

acknowledges the separateness of the object, however, the narcissist views the object as similar to himself or herself in the sense that they share a similar psychological makeup.

In effect the narcissist perceives the object as ‘just like me’. The most evolved

narcissistic personality perceives the object to be both separate and psychologically

different, but is unable to appreciate the object as a unique and separate person. The

object is thus perceived as useful only to the extent of its ability to aggrandize the false

self (Manfield, 1992).

Types of narcissism

Pending the perceived needs of the environment a narcissist can develop in one of two

directions. The individual whose environment supports his or her grandiosity, and

demands that he or she be more than possible will develop to be an exhibitionistic

narcissist. Such an individual is told ‘you are superior to others’, but at the same time

his or her personal feelings are ignored. Thus, to restore his or her feelings of adequacy

the growing individual will attempt to coerce the environment into supporting his or her

grandiose claims of superiority and perfection. On the other hand, if the environment

feels threatened by the individual’s grandiosity it will attempt to suppress the individual

from expressing this grandiosity. Such an individual learns to keep the grandiosity

hidden from others, and will develop to be a closet narcissist. The closet narcissist will

thus only reveal his or her feelings of grandiosity when he or she is convinced that such

revelations will be safe (Manfield, 1992). Like most personality disorders, narcissism occurs to different degrees in different people and can reveal itself in many ways. Many highly successful individuals may display personality traits that might be considered Narcissistic. So, a small amount of narcissism might be beneficial. For example, many of today’s business leaders and politicians exhibit many of the traits associated with Narcissism. However, excessive Narcissistic behavior can lead to insatiability and disaster.

A narcissist can develop in one of two directions. One of them is the exhibitionist narcissist in which the environment supports his or her grandiosity but feelings are ignored in which he or she continues the cycle thus, trying to restore his or her feelings. This would include the need for attention or attention-seeking tactics like working with charity, voluntary, not-for-profit sector. In most case these are women who want to demonstrate to the world that they are wonderful, kind, caring, compassionate person. Other ways could be playing up an injury or fabricating hate crimes. Another example would be Munchausen syndrome. It is usually a mother, who deliberately harms her child in the intention, of gaining attention from the medical staff. Sometimes the narcissist will work as a nurse or in nursing homes causing death to some and being not detected.

The second type of narcissist is the closet narcissist in which the individual suppress himself from expressing this grandiosity. This narcissist will only reveal his or her feelings of grandiosity when such revelations will be safe and not in public. This could mean having a relationship with someone just to fulfill his needs. He or she would resort to sex. Narcissist partners would be considered his or her objects, not as desire. In this case it is element of conquest and must switch partners very often. Some narcissists like complicated situations such as virgins, married women or men, the more difficult the catch the better. A narcissist might seem to loose interest in sex and in all his sexual partners. The frequency would dwindle to a few times a week to a few times a year. A Narcissist might avoid his spouse and pursue sports, politics or volunteering for anything but sex in order to punish him or her for something, or just because they feel confined to him or her or has lost their freedom.

There are three levels of Narcissism. The extreme level in which there is no separation between the self and the object. The object is seen as an extension of narcissist. An example could be if a narcissist sees himself as unattractive, he would seek someone attractive to fill the need as one. Level two is when a narcissist acknowledges the separation of the object, but still views the object as similar to him or her, sharing the same psychological makeup. Level three is when the narcissist perceives both separate and psychological difference but is unable to appreciate the object as a separate person.

Narcissistic Defense Mechanisms

Narcissistic defenses are present to some degree in all people, but are especially

pervasive in narcissists. These defenses are used to protect the narcissist from

experiencing the feelings of the narcissistic injury. The most pervasive defense mechanism is the grandiose defense. Its function is to restore the narcissist’s

inflated perception of himself or herself. Typically the defense is utilized when someone

punctures the narcissist’s grandiosity by saying something which interferes with the

narcissist’s inflated view of himself or herself. The narcissist will then experience a

narcissistic injury similar to that experienced in childhood and will respond by expanding

his or her grandiosity, thus restoring his or her wounded self concept. Devaluation is

another common defense which is used in similar situations. When injured or

disappointed the narcissist can respond by devaluing the ‘offending’ person. Devaluation

thus restores the wounded ego by providing the narcissist with a feeling of superiority

over the offender. There are two other defense mechanisms which the narcissist uses.

The self-sufficiency defense is used to keep the narcissist emotionally isolated from

others. By keeping himself or herself emotionally isolated the narcissist’s grandiosity

can continue to exist unchallenged. Finally, the manic defense is utilized when feelings

of worthlessness begin to surface. To avoid experiencing these feelings the narcissist

will attempt to occupy himself or herself with various activities, so that he or she has no

time left to feel the feelings (Manfield, 1992).

Conclusion

No matter which approach is utilized in the explanation and treatment of narcissism

it is important to recognize that the narcissistic individual is a complex and multifaceted

human being. Deep inside narcissistic individuals experience tremendous pain and

suffering, for which they attempt to compensate for by the projection of the grandiose

front. These people are not character disordered. They are people tortured by

narcissistic injury and crippled by developmental arrests in functioning which rob them

of the richness of life they deserve. Individual suffering from Narcissistic Personality Disorder usually overestimate their abilities and inflate their accomplishments. They appear boastful and pretentious underestimating and devaluing the achievement and accomplishment of others. Narcissists sometimes fraudulently claim to have qualifications or experiences, which they don’t have.

        Fragile self-esteem is another issue for the narcissist. The need for constant attention, admiration, complements, along with superior entitlement, and expecting others to defer to them help their fragile self-esteem. Greed another trait, expecting to receive instead of give and using any means around them for advancement, to include sexual relations.

Narcissist lack of sensitivity has difficulty in recognizing the needs and feelings of others. They are dismissive, contemptuous and impatient when others share or discuss concerns or problems. To conclude the narcissist is oblivious to the hurtfulness of their remarks or behavior, arrogant, disdainful and patronizing attitude, showing envy, emotional coldness and lack of interest and is quick to blame and criticize others when their needs and expectations are not met.

In today’s society Narcissism is all around us. From the time we awake to the time we fall asleep. The children of today are more self-centered then generations ago. Could the parents be spoiling them too much? Thus by giving them, everything they want, with out some level of frustrations, could possibly lead to narcissistic behavior. We see it on television and think it is normal. Television shows, of men and women trying to be gorgeous and the center of attention, such as the Miss America Pageant. Another show, Survivor, in which there is only one person standing at the end. Other factors, may include material items such as cars, houses, that must be grander then others, shows object relations to narcissism. Eventually narcissism may be a part of everyday life and not be considered a disorder in the years to come.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association, 2000.