Definition, Causes, Symptoms & Treatment

Definition

An individual with narcissistic personality disorder exhibits extreme self-importance, inability to empathize with others and heightened sensitivity to criticism. Self-involvement and lack of empathy characterize this personality disorder.

People with narcissistic personality disorder are frequently perfectionists and need to be the center of attention, receiving affection and admiration, and controlling the situation. To get the attention he craves, he may try to create crises that return the focus to him. Like patients with antisocial personality disorder, this person places entitlement issues at the fore. He feels that the world owes him, regardless of whether he makes a contribution.

Alcohol and other drugs (AOD) can induce states that mimic a personality disorder, but if an AOD-using person with a personality disorder abstains, only the symptoms of the personality disorder will still be evident. AOD use may trigger or aggravate a personality disorder. The course and severity of personality disorders can also be made worse if other psychiatric problems, such as mood, anxiety and psychotic disorders are present.

A patient with a personality disorder frequently uses AODs to relieve her symptoms: to raise self-esteem, decrease feelings of guilt and amplify feelings of diminished individuality.

Narcissistic personality disorder often leads to use of drugs, particularly stimulants. As a disinhibitor, alcohol may help lower anxiety and alleviate depression. A shy person with narcissistic personality disorder may depend on marijuana to relieve her social anxiety, while others use steroids to boost confidence in physical perfection. Without AODs, a person with narcissistic personality disorder may believe that others are overly critical or do not adequately appreciate her good qualities. In a crisis, she may become severely depressed.

Symptoms

Overreacts to criticism, becoming angry or humiliated
Uses others to reach goals
Exaggerates own importance
Entertains unrealistic fantasies about achievements, power, beauty, intelligence or romance
Has unreasonable expectation of favorable treatment
Needs constant attention and positive reinforcement from others
Is easily jealous

Causes

The exact cause is not known. Although onset of the disorder is usually early adulthood, it is likely to be in response to childhood experiences. A psychological evaluation may be performed.

Treatment

Psychotherapy may be useful in getting the individual with narcissistic personality disorder to relate to others in a less maladaptive manner. The following guidelines may help therapists working with these patients, especially those who are also AOD-dependant.

Engagement

Therapists can actually use the narcissistic features of their patients to engage and assess them. To avoid angering the patient, it's important to work with, rather than belittle, the narcissistic ego. A therapist should, for example, address a patient's heightened self-importance and desire for control by saying such things as "Because you are obviously such an intelligent and sensitive person, I'm sure that, working together, we can get you past your current difficulties."

Narcissistic personality traits can also be used to provide motivation for therapy. The patient may be induced to change negative behaviors: a better appearance, improved career prospects, or romantic and sexual conquests can been viewed as a reward for recovery.

Therapists will need to address thinking errors—which may reflect inflated self-esteem ("I'm the star of the office") or hypersensitivity ("My coworkers are trying to get me fired")—that interfere with the patient's ability to work.

While empathizing with the patient, the therapist should offer reality testing. If a patient complains that, "things are really going wrong" or "everyone is against me," the therapist might sympathize, but tactfully point out the reality of the situation and how it could be improved by behavior changes the patient could make.

Crisis stabilization

In a crisis situation, the therapist should assess the patient's defenses, and to put them to therapeutic use. For example, when a patient blames his wife for "calling the police on me," the therapist can mention that the best way to avoid being arrested is to stop getting drunk and hitting her.

Patients with narcissistic personality disorder are often perfectionists. For them, the best way to approach their problems is from a "no-fault" disease perspective. This removes blame from the patient and allows her to perceive her illness as a biochemical disorder, reducing the sense of failure that can make treatment more difficult.

A patient with narcissistic personality disorder tends to become depressed when his feelings are badly hurt, when his defenses have let him down and when he believes his world is collapsing. When wounded, he is at the greatest risk of acting out, either against himself or others. A patient experiencing a narcissistic rage may become homicidal, particularly if he has a need to seek revenge. Because of the intensity of the narcissist's emotions, the counselor needs to deal very carefully with this anger and avoid a power struggle.

Patients believed to be suicidal should be asked to sign a safety contract. To stabilize the patient, a brief, goal-oriented hospitalization may be necessary.

Because HIV-positive patients with narcissistic personality disorder are likely to view themselves as expert lovers, therapists should establish contracts with them to practice safe sex. Otherwise, the wide-ranging sexual encounters that often accompany the narcissistic ego, puts them at high risk for sexually transmitted diseases.

Longer-Term Care Individual Counseling

Ongoing therapy is needed to manage not only the self-aggrandizement, hypersensitivity, and need for control and attention found in narcissistic patients, but also their anger and depression. Individual and group treatments for patients with antisocial personality disorder, including 12-step programs, are often helpful for patients with narcissistic personality disorder. In fact, therapists may want to approach an individual with narcissistic personality disorder as a hypersensitive version of an antisocial personality disorder patient.

Group Therapy

Group therapy may be helpful for patients with narcissistic personality disorder, but the therapist should, tactfully but firmly, place limits on their speaking time so that they cannot control the discussion or focus all the attention on themselves. Explaining that members of the group need to share the time, therapists may want to make a contract with patients with narcissistic personality disorder before each session to encourage pro-social behaviors. Some of these behaviors include:

Limiting speaking time
Not interrupting other speakers
Respecting the feelings of others
Responding to other group members
Listening objectively to responses and feedback from others
It is important to continue to use the patient's behavior traits rather than to attack the narcissistic ego. It's best to be empathic while confronting the narcissist: "I can see that you are hurt to hear that not everyone in the group believes you."

Continuum of Care

For patients with narcissistic personality disorder, the least restrictive treatment environment is preferable. It permits patients to feel that they are in control. These patients are normally moved quickly from inpatient to outpatient levels of care. If they do not like the treatment, they will stop participating. Thus, it is critical not to over-pathologize the patient's disorder with constant criticism. However, acute hospitalization for psychiatric emergencies (such as homicidal or suicidal plans) may be necessary.

Narcissistic patients generally enjoy the attention they receive through involvement in outpatient treatment. Long-term outpatient involvement is critical to maintain a narcissistic patient's pro-social behavior and sobriety. Therapists who strive to build narcissistic patients' strengths and who pay close attention to them in therapy will find them active participants in the recovery process. In addition to their personality disorder and AOD use disorder, some patients may engage in compulsive sexual or spending behaviors that should be addressed therapeutically.

sadgurl wrote:Definition

An individual with narcissistic personality disorder exhibits extreme self-importance, inability to empathize with others and heightened sensitivity to criticism. Self-involvement and lack of empathy characterize this personality disorder.

Narcissistic personality disorder often leads to use of drugs, particularly stimulants. As a disinhibitor, alcohol may help lower anxiety and alleviate depression.
A shy person with narcissistic personality disorder may depend on marijuana to relieve her social anxiety, while others use steroids to boost confidence in physical perfection. Without AODs, a person with narcissistic personality disorder may believe that others are overly critical or do not adequately appreciate her good qualities. In a crisis, she may become severely depressed.
blablablabla

Marijuana to elevate social anxiety? Whoever write this sure knew what he was talking about. </SARCASM>


Treatment

blablabla

Engagement

Therapists can actually use the narcissistic features of their patients to engage and assess them.
To avoid angering the patient, it's important to work with, rather than belittle, the narcissistic ego.
A therapist should, for example, address a patient's heightened self-importance and desire for control by saying such things as
"Because you are obviously such an intelligent and sensitive person, I'm sure that, working together, we can get you past your current difficulties."
[/quote]

Yeah, like that's gonna work.
Use the same tricks we use.

(Yes, I'm in a bad mood.)

I wouldnt do that if I were you.

Shes a moderator. Not even I mess with the mods anymore.

They got power man.

Daniel

Butterfly Faerie wrote:Definition

The exact cause is not known.

PhD in not knowing?????

Butterfly Faerie wrote:"Because you are obviously such an intelligent and sensitive person, I'm sure that, working together, we can get you past your current difficulties."

So intelligent, that he could not solve his problem himself. Now, an incompetent shrink is going to tell him what to do!

Butterfly Faerie wrote:Narcissistic personality traits can also be used to provide motivation for therapy.

Total Disregard??????

Butterfly Faerie wrote:The patient may be induced to change negative behaviors:

May be, or maybe not? Euphemism is not an appropriate treatment method.

Butterfly Faerie wrote:a better appearance, improved career prospects, or romantic and sexual conquests can been viewed as a reward for recovery.

NO! Sexual conquests are the signs of this disorder. NO NO NO!!

Butterfly Faerie wrote:Therapists will need to address thinking errors—

Remember: Ns are Perfect!

Butterfly Faerie wrote:While empathizing with the patient, the therapist should offer reality testing.

What reality???

Butterfly Faerie wrote:If a patient complains that, "things are really going wrong" or "everyone is against me," the therapist might sympathize, but tactfully point out the reality of the situation and how it could be improved by behavior changes the patient could make.

Imagine what will never happen. Feel better that you can NEVER make it happen.

Butterfly Faerie wrote:Crisis stabilization[/b]

How do you stabilise Crisis?

[color=darkred]

Butterfly Faerie wrote:In a crisis situation, the therapist should assess the patient's defenses, and to put them to therapeutic use.

Therapeutic MANIPULATION, Therapeutic RAGE... etc.

Butterfly Faerie wrote:Patients believed to be suicidal should be asked to sign a safety contract.

YES, SIR!!

[color=green]

Butterfly Faerie wrote:Ongoing therapy is needed to manage not only the self-aggrandizement, hypersensitivity, and need for control and attention found in narcissistic patients, but also their anger and depression. Individual and group treatments for patients with antisocial personality disorder, including 12-step programs,

I'll check back with you in 5 years, just to see if you ever got to step #1!

Butterfly Faerie wrote:Respecting the feelings of others
Responding to other group members
Listening objectively to responses and feedback from others
It is important to continue to use the patient's behavior traits rather than to attack the narcissistic ego. It's best to be empathic while confronting the narcissist: "I can see that you are hurt to hear that not everyone in the group believes you.

Narcs could not care less.

Butterfly Faerie wrote:t;]Narcissistic patients

Butterfly Faerie wrote:generally enjoy

the attention they receive through involvement in outpatient treatment.

L

Is the person who wrote this totally insane???

I think I am borderline narc, save for the controlling of others. I let others do what they want but protect myself from them at the same time. Can there be a "too nice" narc?

my lifes a wasteland. and ive always blamed my "drug problem".
but after three days of reading, on npd. it all makes sense, if thats even possible.
. i dont know what to do next, cause it looks like my problems are worse than i thought.until a few days ago i at least, thought i have some qualities, knowledge,[im a know it all] all my collecting [books,pottery, glass etc] my art,my work,or being the best carpenter around. hell, i even learned a couple beethoven piano sonatas, just to impress my impossible to impress father. im nothing...now i really need drugs.all that i am isnt me, now what? i want to go wake my biggest detractor, dad, and say its not my fault. is it?

Both my parents are narcissistic. It's rubbed off on me to an extent. I'm damaged and don't think it'll ever go away. I accept this. It's okay, though. In what I focus on, I excel because of my condition. It's lonely, but just the way it is. The hardest thing for me to learn over the years is that for all of my gifts, I'm still quite idiotic in many things. Even what I excel in, there are still people out there who can do better.

I'm not sure narcissism is entirely incurable. My mother has come around after having a hysterectomy. I guess her hormonal balance was really out of whack before, but after than and the death of my little brother, she finally let go of her pride. Before this, she rarely listened to me if at all. She basically treated everyone as objects. My father rarely listens still. Their lack of decency in many matters has truly damaged me. I'm a hypocrite. I find most things that people do to be idiotic and meaningless. I find myself unable to empathize with people in many circumstances.

Oh well.

It's good to keep in mind that there are concepts like 'healthy narcissism' as introduced by Freud, even a Wikipedia article for it: http://en.wikipedia.org/wiki/Healthy_narcissism

Where it goes bad is when one is unable to conceive other's emotions, or when one is unable to see some of the benefits of acting in the interests of others or for a more stable society in regard to their own long-term benefits.

I really think this is something easily overdiagnosed, it's obviously used often by laymen as a pejorative.

In many cases, I believe people who accuse others of narcissism are also experiencing cognitive distortions. The stereotype of a narcissist is that they "can't empathize" or that they "think they are omnipotent". To me, descriptions like this imply that someone is engaging in exaggeration, describing (and perhaps thinking) in an all-or-nothing manner.

It is more realistic that these people simply have ELEVATED ideas of their potency, and have DIFFICULTY empathizing (or perhaps just apathy towards it, or they choose to disregard their empathic instincts for fear of misinterpreting them). People are so blinded with anger at people who think highly of themselves (so ingrained are we in cultural habits of humility that we absurdly believe the non-humble to be predominantly inferior beings) that I believe they think of them in black and white terms.

In this way, treating so-called narcissists in a hostile manner, I ponder if perhaps the attempt to diagnose this condition is creating a self-fulfilling prophecy. Consider this: when someone perceives someone as narcissistic and treats them in an impolite or condescending manner or is angry with them. A narcissist reflects this behaviour back at them (as persecuted defensive people tend to do when attacked) and this response is then classed as 'symptoms'. Thus confirming the diagnosis which may have been made prematurely, but is then cemented by the response to other's prejudice.

When observing how people come to such judgements, the "narcissist" looks down upon their evaluatory skills and feels misjudged. He then thinks "I would not misjudge myself like this" and thus feels superior in that sense.

Many people are vulnerable to falling prey to cognitive distortions such as "Falsum in uno, falsum in omnibus". In a more reserved sense of what a subconcious thought like that would represent, a person may think "if this person misjudges here, why should I have confidence in their other advice?" At that point, it seems unfair to diagnose resistance and hostile defensiveness to criticism as a symptom of illness when it may simply be a symptom of an unsatisfactory analysis.

This is something I'm very concerned about when you consider that these episodes of 'narcissistic rage' are described as temporary. When it comes to temporary situational episodes, I think much attention should be paid to the situation and the history of interactions between all parties involved, lest we risk generalizing specific kinds of disputes as 'how they always react to any kind of X'

I found this article very informative. It would be an extremely difficult personality disorder to treat but if there is any chance of helping an NPD I think it is worth a try. Kudos to therapists who try! I'm just glad I have my ex-partner totally out of my life and each day, a little more out of my mind!

Has anyone read Knight's list of NPD characteristics? What do you think of them? Any errors you can spot in his list?