Narcissistic Personality (NPD)
What is Narcissistic Personality Disorder NPD?
Narcissistic Personality Disorder (NPD) is a symptom cluster characterized by a universal pattern of grandiosity (in fantasy or behavior), the need for admiration, and lack of empathy. Principally a deficit in self-worth, low self-esteem and incomplete self-identity engrains a dysfunctional thought process which gets expressed in self focused, unemphatic, attention seeking behavior.
Narcissistic people are pathologically uncomfortable in scenarios where they are not the center of attention. In general, everybody likes admiration, acknowledgement, and praise. But people with NPD have an obsessive need to be included, appreciated and admired, and hence cannot tolerate being excluded, criticized or ignored. These situations are exceedingly challenging for their self-esteem.
Narcissistic people are internally wired to demand social control through dominance and leadership. That being said, slightly narcissistic tendencies are not uncommon in some social celebrities and public personalities. In fact, NPDs may select such livelihoods simply to direct the spotlight on themselves. And frequently enough, they succeed. But when this need is compulsive, and they’re placed in situations where they lack power and competence, they endure internal self-criticism.
This, with additional shame, anxiety, rage or fear, might allow for irrational, foolish, even drastic actions to regain control, or to escape such a situation. They are not always dangerous or unpredictable like antisocial personalities (ASPD), but their fragile self-worth can push them to envy, hostility and aggression while their lack of empathy continues to disrupt their relationships.
Like other personality disorders, NPD exists on a spectrum, which means it can range in severity from occasional self-enhancing behavior to incessant attention seeking and self-focused acts that are difficult for friends, family, partners and co-workers to tolerate.
Is NPD a Serious Problem?
The near and dear ones of a mildly narcissistic person could learn to live with the self-obsessed charades. The truth is, NPDs do not cause as much frustration to themselves as they do to others – owing to their lack of empathy. Their behavior could be exclusive to different situations.
Some of them have a hardier sense of self-esteem at work, but feel vulnerable in social settings where they demand importance. Others can be ambitious and successful at work, and also have smooth social skills, but at the same time be relatively fragile in intimate relationships, hence the paranoia, possessiveness and anger towards their partner. Yet others feel secure in personal relationships but tend to frequent human resource offices or leave jobs, because they were not credited well enough at their workplace.
People with NPD have such overpowering self-preservation instincts that their hyper vigilance and emotional reactivity to rejection makes them impulsive. In severely pathological or malignant narcissism, aggression can become seriously destructive or revengeful with controlled manipulativeness, or imprudent actions like suicide and homicide. NPD is a serious condition and unquestionably needs help.-
What Causes Narcissistic Behavior?
Like most psychological conditions, narcissistic personality disorder does not have one pinpointed cause, but a combination of genetic, biological, psychological and social factors do contribute to the final presentation of an NPD persona. NPD individuals tend to have family members with similar impulsive and emotionally insecure personality traits. Brains of these individuals are prone to neurotransmitter deficits, likely responsible for their low self-perception, lack of empathy and reactive impulsive tendency.
That being said, narcissistic people have “insecure inner working models” which make them perceive themselves as unworthy and unwanted. Hence their outer attempt at flamboyant and extravagantly garish expressions, that demand attention and acknowledgement.
They invariably have chaotic childhood family environments with poor supervision from adult role models. Needless to say, traumatic experiences of childhood (abuse in any form, or neglect) leave lasting imprints on their mind, which results in loss of empathy. In an effort to stop feeling pain, they stop emoting completely. Such people give up any expectations of reliability and trustworthiness because they assume it is impossible to achieve. So, their frenzy of lies and treachery continues.
NPDs don’t care or feel close to anyone because their brain is not geared to do so. It is true that some degree of that such behavior could be reported by individuals without NPD too, but the underlying psychological vulnerability in these individuals results in expression of the entire syndrome cluster which can be quite distressing to people around them. Because they are charming and smooth talkers, many fall prey to their sham, and get stuck as if in a spider’s web.
Symptoms and Diagnosis of NPD
NPD: Self Concept
- Absent sense of the self
- Inadequate self-esteem
- Acknowledgment needs
- Exaggerated self-appraisal
- Vacillating self-confidence
NPD: Relationships
- Superficial associations
- Held for personal profit
- Insincere charm and wit
- Lack of genuine interest
- Exist to serve the self only
NPD: Empathy
- Lack of any real emotion
- Ignorant of people’s needs
- Cannot perceive emotions
- Taking advantage of others
- Envious of others’ success
NPD: Grandiosity
- Firm mindset of entitlement
- Selfish and self-centeredness
- Condescending toward others
- Arrogance and haughtiness
- Fantasizing power and success
NPD: Attention seeking
- Persistently seeking admiration
- Attracting attention in public
- Loud and intense showiness
- Redundant outlandish behavior
- Taking focus away from others
NPD: Ideals and Ethics
- Unaware of own motivations
- Create their own rulesets
- Goals focused on approval
- Inflated sense of purpose
- No respect for authority
It is important to observe that all of the above traits of narcissistic people are contextual to those they interact with. People with narcissistic personality disorder tend to suffer few symptoms themselves, except times when their self-esteem vacillates to an all-time low and they exaggerate it again with grandiosity. All discomfort and distress are otherwise saved for others through their patronizing behavior.
Why Management of NPD is Challenging
Typically, a person with narcissistic personality disorder may be reluctant to seek treatment and may only start therapy if coaxed by a partner or family member. When those on the milder side of the spectrum and possessing some degree of insight, seek help by themselves, they do show transformation.
Therapy involves collaborative explorations of unconscious and automatic defenses which need to be brought to light with self-awareness. It is difficult to give up ingrained patterns of self-enhancement, manipulation and control because these are internally rewarding. Hence the focus of therapy is on taking ownership of competence and achievements to stabilize self-esteem, and lower self-criticism, insecurity and self-devaluation, which motivates them to uplift themselves by berating others.
How Does Psychotherapy Work for NPD?
Psychotherapy in NPD focuses on changing negative views of the self, others, and the world. Cognitive techniques like Cognitive techniques like CBT (Cognitive Behavioral Therapy), REBT (Rational Emotive Behavior Therapy), ACT (Acceptance and Commitment Therapy) and Humanistic techniques like EFT (Emotion focused Therapy)to name a few; all work on dysfunctional thoughts, emotions and behaviors that contribute to unreasonably negative thoughts and self-focused indulgences.
This is attained in six steps. First, identifying and reaching an agreement about the existence of a problem. Second, focusing on self-esteem rather than emotion and behavior. Third, non-judgmental validation of problems and challenges from the client’s point of view. Fourth- activating the client’s reflective ability and self-assessment. Fifth, establishing goals for change, and sixth, enhancing personal traits and challenging self- propagating tendencies. A combination of cognitive, behavioral and emotive techniques helps achieve these steps.
Cognitive Behavioral Therapy (CBT) enhances mindfulness and stress tolerance, lowers impulsivity, and can enhance interpersonal effectiveness through social skills training. It also rebuilds an absent or dysfunctional self-esteem. Mentalization based Therapy focuses on attachment styles and tries to restructure the lost self-concept. Relaxation training and desensitization are behavior therapy (BT) approaches which work on controlling the automated anxiety and aggressive responses to perceived threatening situations.
Therapy Goals in NPD
- Reduce demandingness and self-focus
- Identify negative irrational thoughts
- Defy distorted, harmful expectations
- Replace these with positive beliefs
- Analyze feeders of low self-regard
- Reframe the hopelessness to hope
- Fight dependence, build self-esteem
- Inculcate logical problem solving
Target Outcomes in NPD
- Improved interpersonal relationships
- Better adaptation to crisis situations
- Enhanced tolerance to frustration
- Greater resilience and stress coping
- Enhanced communication skills
- Reclaimed self-confidence/ esteem
- Realistic emotional and life goals
- Awareness of negative automatisms
MINDFRAMES role in NPD
Every NPD individual’s self-regulation is unique, based on their internal mental models. Also, the patterns of emotional unrest can be very personalized. Time-tested and evidence-based psychotherapy techniques are available for NPD symptom management, as well transforming internal schemas. But the final approach must always be customized to the individual’s needs. Treatment is challenging, but a committed therapist-client duo can make self-change happen.
Psychotherapy is for everyone because nobody is free from stress, uncertainty and insecurity. As a psychiatrist and psychotherapist practicing distinctive therapies, Dr Shefali guides you through cognitive, mindfulness and neurobehavioral milestones to help you think, feel and behave more purposefully. How you feel matters. Do something about it.
References
- Akhtar, S., Thomson, J. A., (1982). Jr Overview: narcissistic personality disorder. Am J Psychiatry; 139(1):12–20.
- Pincus, A. L., Lukowitsky, M. R., (2010). Pathological narcissism and narcissistic personality disorder. Annu Rev Clin Psychol;6:421–46.
- Pincus, A., Roche, M. J., (2011). Narcissistic grandiosity and narcissistic vulnerability. In: Campbell WK, Miller JR, editors. The handbook of narcissism and narcissistic personality.
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