Personality can be considered as a summation of individual behaviours1 and thought process of the long standing persistent and consistent characteristics. Personality disorders on the other hand, are enduring and pervasive patterns that deviate in cultural contexts, have an inflexible pattern, and lead to distress2. Such disorders are diagnosed in adolescence or early adulthood and remain stable over time.
Narcissistic personality disorder (NPD) is a pervasive pattern of grandiosity, need for admiration and lack of empathy2. Individuals with this disorder may appear to be highly self-appreciating, but in fact are very vulnerable to threats to self esteem3. Such a person may exhibit self confidence, but in reality is often suffering through issues such a ego problems, disdain, and insecurity.
The features of narcissistic personality disorder include the following2:
- Grandiose sense of self-importance
- Fantasies of unlimited success
- Sense of entitlement
- Overdependence on admiration from others
- Sense of entitlement (i.e., unreasonable expectations of especially favourable treatment or automatic compliance with his or her expectations).
- Manipulative in interpersonal relationships
- Lacks empathy
- Envious of others
Individuals with this disorder are very prone to self-esteem issues. Thus, even the slightest criticism can be damaging to their fragile sense of self. Even with high ambition and confidence, their performance may get disrupted due to intolerance to criticism. In addition, NPD is also associated with depression, eating disorders and substance use disorders.
The management of NPD is a multi-faceted process. This is because, most individual’s face difficulties related to relationship issues, work performance issues, substance use, etc. In addition, it is difficult for them to come to terms with their own problems. It is highly imperative for a trained professional to be patient as therapy for NPD is a long term process. Different kinds of psychotherapeutic approaches can be applied to the management of NPD, like:
- Psychodynamic psychotherapy: In a psychodynamic therapy, a therapist often deals with the client’s defence mechanisms. These mechanisms are unconscious and pervasive and therefore, require an in-depth analysis by the therapist. Therapists may use direct confrontation as a method of improving client’s view of their maladaptive tendencies. At other times, a therapist may provide unconditional support to the client, as they may not be able to accept any confrontation in therapy either.
- Cognitive Behavioural Therapy: In this therapy, the therapist uses strategies that increase awareness about how their behaviour impacts their interpersonal relationships. Some of the techniques used are; role playing techniques, introspection, etc.
The clinical picture of NPD often requires sustained management and long term monitoring by professionals such as psychiatrists and clinical psychologists. Special attention is required to maintain adaptive social relationships, ability to regulate emotions and tolerate issues related to self esteem.
1.Cohen, R. J., Montague, P., Nathanson, L. S., & Swerdlik, M. E. (1988). Psychological testing: an introduction to tests and measurements. Mountain View, CA: Mayfield Publishing Co.
2.American Psychiatric Association. (2013). Personality disorders. In Diagnostic and statistical manual of mental disorder (5th ed.). Washington, DC: Author.
3.Kay, J. & Tasman, A. (2006). Essential of psychiatry. West Sussex, UK:John Wiley & Sons Ltd.
4.Sperry, L. (2003). Handbook of diagnosis and treatment of DSM-IV-TR personality disorders. New York, NY:Brunner-Routledge.
Narcissistic Personality Disorder