Clinical Features of Narcissistic Personality Disorder

Personality can be considered as a summation of individual behaviors and thought processes of 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 distress. Such disorders are diagnosed in adolescence or early adulthood and remain stable.

Narcissistic personality disorder (NPD) is a pervasive pattern of grandiosity, need for admiration, and lack of empathy. Individuals with this disorder may appear to be highly self-appreciating, but in fact, are very vulnerable to threats to self-esteem. Such a person may exhibit self-confidence, but in reality often suffers from issues such as ego problems, disdain, and insecurity.

Clinical Features

The features of narcissistic personality disorder include the following:

• 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 favorable treatment or automatic compliance with his or her expectations).
• Manipulative in interpersonal relationships
• Lack of empathy
• Envious of others
• Arrogance

Individuals with this disorder are very prone to self-esteem issues. Thus, even the slightest criticism can damage 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.

Management

The management of NPD is a multi-faceted process. This is because, most individuals 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 psychodynamic therapy, a therapist often deals with the client’s defense mechanisms. These mechanisms are unconscious and pervasive and therefore, require in-depth analysis by the therapist. Therapists may use direct confrontation to improve clients’ views 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 behavior 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, online psychologists, and clinical psychologists. Special attention is required to maintain adaptive social relationships, the ability to regulate emotions, and tolerate issues related to self-esteem.