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What is Narcissistic Personality Disorder?

A Narcissistic personality disorder is characterized by an extreme sense of self-worth and an increased need for admiration. Narcissistic individuals are also in a habit of inflating their accomplishments. Their increased need for admiration makes them less tolerant of criticism from others. This affects their interpersonal relationships as they stop interacting with those who do not admire them. Individuals with narcissistic personality disorder have unrealistic standards for evaluating others and always perceive them as lacking. Due to this perception of others as lacking, they often used to change their partners and like to be those with higher status. Their arrogance, lack of consideration is accompanied with envious feelings towards others. This further distorts their interpersonal relationships. In the general population, the prevalence rates for narcissistic personality disorder range from 0% to 6.2%. Also, it has been found that those diagnosed with narcissistic personality disorder are 50 to 70% males.

Symptoms of Narcissistic Personality Disorder

The pattern of all symptoms is pervasive and longstanding. The following are the symptoms of narcissistic personality disorders that are observable in various contexts usually begin in early adulthood.

  • Narcissistic individuals have an exaggerated sense of self-importance and used to devalue others’ accomplishments. 
  • They irrationally believe that they are superior to others and having unique qualities and want others to perceive them the way they used to see themselves. 
  • They used to idealize, compare and associate themselves with those having a high status in society e.g. trying to have friendships with those who are at high posts.
  • Their insistence on being the best and above all is also reflective of the choices they made e.g. choosing the best institutes they study.
  •  The increased demand for admiration of narcissistic individuals is disproportionate to their achievements e.g. they want to be praised and complimented even when no significant success is made.
  • They have an increased need to be the center of attention of others e.g. they may want that other delightfully welcome them when being to a party.
  • Individuals want their needs to be fulfilled under all circumstances regardless of being considerate towards others.
  • The need for special treatment from others and lack of concern towards others’ need, makes the individual mean and selfish such that they began to use others for their desire fulfillment.
  • Individuals used to envy those with having certain achievements and believe that they are more deserving. 
  • The narcissistic individuals are arrogant and often used to make fun of others in order to make them feel inferior to them. 

Factors Responsible for Narcissistic Personality Disorder

The following are the two factors that are likely to be highly influential in the development of narcissistic personality disorder.

In parenting factors it has been that two types of upbringing patterns are likely to be prevalent in individuals having narcissistic personality disorder:

Parental coldness is described as when parents do not respond to a child with respect, warmth, and empathy, this would result in an insecure sense of self. These insecurities in self then began to manifest in negative ways as observable in narcissistic individuals e.g. their consistent demand for being admired by others. 

The second factor found in parents of narcissistic individuals is their overemphasis on a child’s achievement. This means that the parents tend to praise their children’s success, in an overly exaggerated manner. This results in formulating a false belief about themselves. 

In cognitive factors, it has been found that narcissistic individuals have fragile self-esteem. This fragile self-esteem is reflective in a way that they constantly monitor how they are doing and how others are regarding them. They are in a constant struggle to maintain their image of being special.  This cognitive goal of bolstering self-esteem is also considered as the main goal in interpersonal interactions.

Modules For Psychological Treatment

The treatment for narcissistic personality disorders (NPD) is often challenging for two reasons. Firstly, it is very difficult to convince the patients to step forward for the treatment. Secondly, since NPD is a personality disorder so the treatment is also prolonged. Following are the steps of psychological treatment for treating NPD:

  • Building an alliance with the patient is the first step. This is usually done by first strengthening the patient’s narcissism rather than minimizing it as criticizing or competing would offend the narcissistic individual.
  • In the second step treatment is centered around a psychological therapy primarily being used are:

In cognitive behavior therapy firstly the negative cognitive beliefs are elicited in order to gain insight about the pattern of symptoms. The dysfunctional beliefs in case of narcissistic personality disorder might include e.g. “I am much better than others in all respects”, “People of my intellect are rare”. These negative beliefs are then challenged by providing evidence contradictory to it.

In emotional regulation, techniques are aimed at increasing the patient’s ability to tolerate the criticism of others without getting angry and to discern self-hatred if the need for admiration is not fulfilled. 

Mentalization-based therapy is primarily carried out to focus on the issue of narcissistic individual’s incapability of thinking about their own and others’ feelings. In this therapy, the therapist’s goal is to enable the patient is to engage in a more active, thoughtful approach to interpersonal relationships and feelings.

Treatment with medicine

As with other personality disorders, the medicines are used for symptomatic management. For example is there are anger issues, sleep disturbances, etc. For this, a low dose of antipsychotics and sedative antidepressants can be used. Another indication to start medicine is that if there are other concurrent psychiatric illnesses such as depression, anxiety disorders, psychotic illnesses, etc.

Case study

B. A, a 45-year-old, male university professor, came to the psychiatric outpatient department of a government hospital to seek treatment after being intensely convinced by his wife. While the interview being conducted with B.A, he appeared to be so focused on himself and his own achievements. Also, he was belittling the efforts of his coworkers by saying that his competitors are the real fools. He was unconcerned of these concerns by saying that he had never been tolerant of the fools as he could see no reason why he should begin offering such tolerance now. He also said that his former friends, parents are lacking the intelligence to merit his friendship even. He also bragged about his position in the university and how he is an epitome of success for others. B. A’s wife reported that his husband is always used to demean the efforts she carried out to please him. After the complete history was obtained from the patient and wife he was diagnosed with Narcissistic personality disorder. Both drug therapy and psychotherapy were started aimed at challenging unhealthy beliefs. The treatment was difficult at the start however, after a one and half year period of psychotherapy some improvement was observed and reported by his wife.

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