Mental Health Watch: Narcissistic Personality Disorder

Good Mental Health
Dealing with Narcissistic Personality Disorder

Flagstiffed provides this feature as a public service to help employees deal with a difficult personality type.

The general description of the personality disorder comes from AllPsych and Heffner Media Group, Inc.

We consulted with a professional who has extensive clinical experience in both individual and group psychotherapy settings to offer a commentary that is written in blue italics.


Narcissistic Personality Disorder

Etiology
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Like most personality disorders, there are many factors that may contribute to the development of symptoms. Because the symptoms are long lasting, the idea that symptoms begin to emerge in childhood or at least adolescence is well accepted. The negative consequences of such symptoms, however, may not show themselves until adulthood.

(Conventional psychotherapeutic models of the narcissistic personality tend to attribute it to a psychic wound inflicted in childhood. For example, an abusive father may produce the disorder in his son for whom the narcissism becomes a form of protection against the father’s emotional assaults. Narcissistic disordered patients are often ACOA [adult children of an alcoholic parent] whose narcissism was developed as a protective shell. Narcissistic adults frequently seek out other narcissistic adults as their mates and partners since they both view the world as a dangerous place filled with people who are out to get them.)

Symptoms
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The symptoms of narcissistic personality disorder:
1. Revolve around a pattern of grandiosity, need for admiration, and sense of entitlement. (The narcissistic patient frequently surrounds himself with people who flatter or praise him and rebuffs those who criticize or disagree with him.)

2. Often individuals feel overly important and will exaggerate achievements and will accept, and often demand, praise and admiration despite worthy achievements. (The narcissistic patient often displays emblems of success and admiration, no matter how trivial or insignificant, such as awards, certificates, and prizes, or brags about supposed accomplishments, which are often exaggerated or are actually the product of others’ labor.)

3. They may be overwhelmed with fantasies involving unlimited success, power, love, or beauty and feel that they can only be understood by others who are, like them, superior in some aspect of life. (The narcissistic patient blames others for problems for which he is responsible and is unable to accept responsibility for mistakes or to apologize for harm he has caused.)

4. There is a sense of entitlement, of being more deserving than others based solely on their superiority. (In a curious twist, this sense of superiority can be masked by a false pose of humility while simultaneously existing as a symptom of a fundamental insecurity.)

5. These symptoms, however, are a result of an underlying sense of inferiority and are often seen as overcompensation. (Underlying all of the narcissistic patient’s bragging and displays of supposed accomplishments are a deep, abiding, and intractable insecurity, sense of shame, and fear of being exposed to ridicule.)

6. Because of this, they are often envious and even angry of others who have more, receive more respect or attention, or otherwise steal away the spotlight. (The narcissistic personality can become very paranoid, questioning the loyalty and motives of those around them. They also tend to “infect” their associates with the same paranoia and sense of emergency or urgency in stressful circumstances.)

Treatment
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Treatment for this disorder is very rarely sought. There is a limited amount of insight into the symptoms, and the negative consequences are often blamed on society. In this sense, treatment options are limited. Some research has found long term insight oriented therapy to be effective, but getting the individual to commit to this treatment is a major obstacle.

(The narcissistic patient abhors situations where he appears to have made a mistake, blames others for his personal problems or for problems that he has caused, feels himself to be the object of undue scrutiny, and in some instances exhibits a paranoia in which he imagines others are out to get him. He is unable to acknowledge the extent to which he is the cause of his own problems or the extent to which he causes pain and suffering in others. Therefore, when his disorder causes others distress, he is unlikely to acknowledge the pain and suffering that he has inflicted on others, much less to apologize, to remedy, or to change. Seeking treatment requires an individual who has some degree of self-awareness, empathy, and ego strength, which the narcissistic personality typically lacks.)

Prognosis
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Prognosis is limited and based mainly on the individual's ability to recognize their underlying inferiority and decreased sense of self worth. With insight and long term therapy, the symptoms can be reduced in both number and intensity.

(Narcissistic personality types can be very dangerous to those associated with them. When asked how one should deal with a narcissistic personality, the clinician’s best answer is, With as much distance as possible!)

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