Overview of Narcissistic Personality Disorder

Overview of Narcissistic Personality Disorder

BACKGROUND

Narcissistic personality disorder (NPD), has been clearly defined by Diagnostic and Statistical Manual of Mental Disorders as one among 10 disorders associated with the personality. These disorders have been perceived to be the inner behaviors and experience enduring pattern with a high rigidity and deep set of bringing the person into divergence with the occupational and social surrounding. These patterns that are dysfunctional are perceived as not conforming resulting to noteworthy pain emotionally together with relationship difficulties. There are various problematic behaviors that a person should have, to meet the personality disorder diagnosis which are; (1), the interpretation and perception of the self and others (2), the strength in the feelings and durations and situations appropriateness  (3), the impulse control ability and (4), the association with others. It should importantly be noted that all the personality disorders are usually perceived to begin at the onset of the adolescence towards the early adulthood. The resistance of the doctors to administer the narcissism personality disorder diagnosis to the young children is usually based on the assumption that these children are still at their growth process and there may be a possibility of these traits changing considerable by the time they approach their late teenage period.

LITERATURE

More specifically, Samuel and Widiger (2008) perceive NPD as a grandiosity pattern in the private fantasies of a patient, a need to be admired constantly by others. The story of Narcissus and Echo (from which the term narcissism is derived) was first according to Samuel and Widiger (2008), used by Havelock Ellis; who is a British psychologist back in the year 1898 as psychological self- absorption capsule summary. Ever since, the words narcissistic and narcissist have been the psychology vocabulary part. For the purpose of understanding NPD it would be important to have various theories outline on human beings in relation to narcissism. Among the DSM –IV –TR personality disorders, NPD has been perceived to be unique based on the understanding that it is connected to an array of discontents and problems.

Watson et al (2002) perceives that nine diagnostic criteria are specified for NPD. Watson notes that in order for the diagnosis to be made by the clinician, there are certain description that an individual has to fit in: (1), Having a self- importance grandiose sense (2), living in a fantasy world that is overwhelmed by success, genius, beauty and power among others (3), thinking of individual self as special based on the understanding that it is only the others that are special and of high status that can understand them (4), demanding a lot of admiration and praise from others (5), a feeling of entitlement to difference that is automatic as well as treatment that is favorable from the others (6) , exploitation towards others in addition to taking advantage of the other people (7), lack of empathy and failure to recognize the others feelings (8), frequent feel of envy together with having the “attitude” which drives them to talking or frequently acting arrogantly.

NPD is in addition according to Simon (2002) grouped with other three personality disorders. The grouping is based on the similarity in the symptoms; based on the fact that the patients that are suffering from these disorders are usually perceived have instability, extreme emotions and self-dramatizing characteristics. However, the clustering system is not an indication that the criteria of substance abuse and moods among others will be met by all the patients that have these personality disorders.

 

NPD subtypes

            Since the year 1950 when an increased number of patients was realized to have narcissistic disorders, attempts have been made with an aim of defining these disorders in a more precise way. After the discovery of NPD, it was initially perceived to have been untreatable virtually based on the fact that the people suffering from this disorder have rarely remained under the treatment, with a typical habit in which they tend to regard themselves as more superior when compared to their therapists with a notion whereby they perceive their problems to have been caused by the “stupidity” of other people. However, the proposal by some psychiatrists have been aimed at dividing the narcissistic patients broadly into two groups on the basis of age; the young adults with a narcissism that can through life be corrected and those adults whose suffering from narcissism is more stable. The distinction on the basis of age groups is a representation of an ongoing controversy that is based on the NPD nature- whether it is a disorder based on the character or a matter of a behavior that is learned in which there can be unlearning.

Simon (2002) maintains that other patients meeting the NPD criteria have a reflection of different traits clusters. According to an expert in the NPD field, various subcategories have been suggested for the narcissistic personalities. Craving narcissists has been categorized as the people with an emotional need as well as a feeling of being undernourished, and may have a possibility of appearing clingy as well as demanding. Paranoid narcissists usually have a feeling of intense self contempt although this feeling is sometimes projected outwards to other people. This category is usually known to drive away other people from them through comments that are jealous and hypercritical together with such behaviors. The manipulative narcissists are usually perceived to enjoy when they pass over their burden to others. Through such act, they are usually able to have a feeling of being superior through manipulation of others. Coid (1999) notes another category of the narcissists that are mainly male and tends to have a tendency of aggressiveness, being athletic as well as portraying pride in showing their “manliness”

The indispensable distinctiveness of narcissism personality disorder; based on a study carried out by the American Psychiatric Association, (2000) has been seen to include self importance grandiose sense, lack of empathy, entitlement as well as  using others for individual gains. Most of the people suffering from NPD have in most cases been seen have preoccupation with thoughts and day dreams or even imagination that is preoccupied with power and success. In other circumstances, it has been quite often to note that those people with NPD have had little to count on in terms of success or achievements that can be termed as significant. Due to the idea of preoccupation with power and success, credence has been lend to the theory that has been based on the fact that these people have been known to be risk takers. Ronningstan, (2005) maintain that these individuals are not willing to stand the idea of appearing to be less intelligence when compared to the other people that they associate with. The study has further shown that there is a similarity in the principle component that usually leads people to narcissism. The idea of similarity as the imperceptible strength behind narcissism results to insights that are involved in many of the NPD characteristics. Depression in the individuals suffering from NPD has been perceived to arise from many personal issues, in reference to which Ronningstam (2005) points that these victims express envy if they are deprived from praise and instead others are commended. However, (Ronningstam, 2005) observes that this depression usually do not last for a long time. With this condition, the victims usually tend to externalize and see setbacks in addition to taking stock in their own superiority and mastery sense over the other individuals. In addition, in the bind to sheltering their self-sense which has been characterized with fragility, they usually have a surety that there is envy in them from the others that are around them. This now brings an even clear explanation on why the NPD victims have in most cases been considered to be detached or even not possess an interpersonal relationship that is strong. However, their self conscious may be leading them into believing that they actually do have numerous relationships that they are close to, from which they usually receive a lot of praise.

The Narcissism Personality Disorder etiology

            According to Gunderson (2001), the narcissistic personality disorder etiology has always remained unclear. The studies that have been carried out have not been able to clearly portray the disorder hereditability. Basically the etiology theories have been psychodynamic, sociological as well as interpersonal.  For instance, the western society has been perceived to have become self centered overly with an importance that is decreasing being given to the bonds that are familiar together with increasing importance being given to the self-esteem, materialism as well as self satisfaction. Through the excessive narcissism, there may also be partial development through the affection and parental attention contingent provision. Through the parental relationship, the child may learn that there is a contingence in the sense of worth, meaning and value upon achievement or accomplishment. However, the perception that is held by other psychologist is that narcissism results from reception of idealization that was excessive by their parents which were incorporated by them onto their self image. There is an appearance of the deficits and conflicts in relation to self esteem which do appear to be central to the Narcissistic personality disorder psychopathology. There may be a likelihood of the narcissistic person continually seeking and obtaining the symbols and signs of recognition to the inadequacy feeling compensation. There is the contingence of the self esteem upon accomplishment, success or status. Their insecurity feelings may be masked by indifference overt or a devaluation that is disdainful of the other people’s opinions, although there may still be evidence of pathology in such cases by a reliance that is excessive with the recognition and status being highly valued. In addition, there may be envy by some narcissistic individuals that are truly indifferent to criticisms and success and who find fantasy in unassuming and simple life.

Freud (1990) postulates that narcissism is an instinctual drive of a person that is aimed at preservation of oneself.  It is on this basis that Freud argues that the society aims are usually driven towards masking the future of illusion from ourselves. Based on Freud (1990) postulation, the origin of narcissism can be traced back to the early childhood in which the child is usually subjugated to aspirations and desires that cannot be realized. Due to this, there is usually a weakening of the ego to the compensation point. As a result of the children not feeling the parental love, what usually ensues is love for one self. This is what is claimed by Freud to be the narcissism etiology

The other notion on narcissism according to Freud (1990) seems to be one way or another moot. The idea that is based on the perception that there is a survival instincts in a person and the choice will naturally be based on his or her self instead of the others has been challenged by other conception that will include depression, suicide together with other mental illnesses. This calls for the need to lay a new framework on the causes behind narcissism. According to theories that are more recent by Davis and Millon (1999), the argument on the biosocial model is based on the argument that the parents that are overindulgent usually foster to their children a sense of being special and entitled. It is based on this that there will be an expectation of praise by these children on all the endeavors regardless of whether it is of a significant value or not. The conception of biosocial model takes the parents overindulgence even a step further based on the cognitive theories. A suggestion is held based on the notion that the parents instilling a specialness and entitlement sense through which the children are actually deprived the experience that consists of a wide range of effects. It is based on this that the child will experience the emotions which will include pride or happiness instead of anger and sadness. This explanation is a coincidence to the DSM-IV TR sixth criteria in which the selfish is seen to take advantage of others empathy lack according to criteria 7. Since it is only the positive emotions that are usually experienced by the child, it is mostly not possible for them to handle the emotions that are negative or even relate to the emotions of the encounter by the other person. Ronningstam (2005) however points out that the there has not been enough research on the environmental or dispositional influence to have this determination made on NPD.

According to Samuel and Widiger (2008), there seems to be an agreement with Freud (1990) when it comes to tracing the NPD roots to the origin family disturbance, especially to the issues that concerns the relationship between the parent and child when the child is still young before the age of three. However, the disagreement is based on their account of these problems nature. The growth of the child to the primary narcissism is usually caused by the opportunities that are to be reflected by their parents; through which a more realistic self sense is acquired together with personal values and ideals set based on these two processes. However, failure by their parents to provide opportunities that are appropriate for mirroring and idealization makes the child to remain stuck at the stage of development in which there is a possibility of having the self sense remaining unrealistic and grandiose while at the same time depending on the approval for their self- esteem. The view of NPD is depicted in contrast as rooted in the defense of the child against a parent that is cold and not empathetic. With the emotional hunger and anger of the parent who is depriving, the child is usually perceived to have a withdrawal into a self part that is valued by the parent whether based on the looks, ability intellectually together with other talents or skills. This is the self part that is usually perceived to become grandiose or hyper inflated. This usually results in spitting off of any weakness that is perceived into the self part that is hidden. Through splitting, a long life tendency emerges; which is usually perceived to swing between the grandiosity two extremes coupled with a feeling whereby the patient usually feels empty and worthless. Samuel and Widiger (2008) affirm that in both accounts, there is development of the child into the adulthood with a history of relationships that are unsatisfactory with others. In the adult narcissist, there is basically a possession of a self- grandiose view with psychology that is conflict ridden and based on dependence on the others. However, Ronningstam (2005) argues that presently there is no agreement by the psychiatrists based on their way that they centrally understand the defect of NPD. Some hold strong to believing in the primary emotion of the problem with others regarding it as resulting from cognition that is distorted. There are other psychologists that perceive that there is hunger and emptiness in the person with NPD with others arguing that there is usually a disorganized self in narcissism. There are still others that refer to the major problem as the inability of narcissists to have a reality test or have an accurate constructive view.

Some interesting results have been revealed by the twin studies in terms of the NPD influence genetically. In one study, it was particularly found out that 493 twins pairing had a heritability of 45% by the use of Dimension Assessment of Personality Problem scale according to Jang et al, (1996). There is yet to be a replication of further studies in which important insights may be provided on the NPD biological origins. However, based on other Neuropsychology studies, it has been found that responses of neuronet are usually developed by the infants in a specific pattern as they react to styles of parenting (Schore, 1994). As the child is exposed to stress, there is usually a back reverting based on a particular behavior pattern of the neuronet. In a study by Schore (1994), two parenting styles were indentified through which there would be a contribution to the NPD development. There is first the resistance that is insecure that is connected to the style of parenting. Due to this parenting style, there is a contribution of hyper activation as well as under regulation of effect (Ronningstam, 2005). This results in a grandiose of self importance and entitlement sense coupled aggression that is usually directed to other people. Depressive hypo repressive is the second parenting style, which may result to overregulation of affect and low energy. It is the depressive hypo arousing that has the potential of resulting to the shy type of narcissism. The appearance in these individuals is usually timid with signs of fragility sometimes.  However, a closer examination of these individuals finds them to have a fantasy life filled with grandiose and a lot of activeness. As a result of the genetic and neuropsychological examination of the NPD, some insights are provided to the future assessment as well as the options of treatment. However, there is a need for conducting further research which should be aimed at obtaining a even clear picture that can result to understanding the origin of NPD genetically and also from the neuropsychological perceptive.

Macrosocial cause

            Grandiosity has been regarded by most observers as the trait that is most important in the narcissistic personality. It should however be importantly noted that grandiosity has an implication of more than just display of pride or boasting, it is an indication of self- aggrandizement that is not sourced from the reality. For instance, a person claiming to have been the most valuable player in the athletic team of the college may be having the probability of telling the truth about their sports record during their undergraduate study period. There many are some bad manners in their claim but however, this cannot be perceived as grandiosity. However, there may be another person that may be making a claim while he had a record that is undistinguished or he even was never part of the team may result in grandiose. In the NPD, the grandiosity has been connected to some of the criteria of diagnosis that includes special favor demands or using the basis of high status and prestige when choosing the associates and friends and not based on the personality qualities. In addition, the narcissist’s diagnostic assessment is complicated by the grandiosity based on the fact that it has been seen to frequently result to misrepresentation and lying of the past history of an individual as well as the accomplishments in the present.

Simon (2002) notes that there are various functioning that are usually represented by the people that are diagnosed with NPD. Based on the description of Simon, there are three narcissistic impairment levels. The first category consists of the individuals that are sufficiently gifted and talented to have an attraction of all the attention and admiration as they want; the reason for these people not entering therapy is usually based on them not having the desire to do so. There is also the category of the individuals that have a satisfactory functioning in their occupation although they seek help professionally based on their understanding that they are usually unable to form a relationship that is healthy and due to the tendency of feeling aimless and bored. The lowest level of narcissists has the history of having been diagnosed with a mental disorder or have ever been involved in troublesome act with the law. This category has been perceived to have difficulties that are severe when it comes to impulses control and anxiety.

Narcissistic personality assessment

            The MMPI development was initially used in primarily detecting the Axis 1 mental disorders, although it is at times used in detecting the personality characteristics that are maladaptive in the individuals that are affected by the psychological disorder. From the MMPI, there are several scales that have been developed with an aim of assessing narcissism according to Rathvon and Holstrom (1996). The MCM –III-R has been another personality measure that has been commonly used in which there is specific scale for the narcissism assessment. While the designing of the MCR- III-R and the MMPI-2 have been aimed at measuring the personality, Samuel and Widiger (2008) notes that perhaps the NPI (Narcissism Personality Inventory) is the scale that is specifically designed directly measuring the narcissism. Samuel and Widiger (2008) highlights that there are several studies indicating that NPI has the ability of measuring various narcissism facets in a way that is moderately accurate. The NPI lack of sensibility may be based on the fact that there are several of its subscales that are usually aimed at measuring the personality pathology that are at a more global range against the narcissistic traits that are more specific. Even though, various other studies are based on the argument that NPI has the ability of capturing the narcissism complexity, and presenting it in a new continuum form that ranges from pathological narcissism to functional narcissism (Watson et al, 2002).

An examination was done by Samuel and Widiger (2008) on the validity construct of the NPI with a comparison being done to three other narcissism measures that included the MCM-III. This examination was initially not able to determine if NPI was actually useful in measuring the narcissism. However, in the second and third studies, there was indeed a confirmation of a strong validity construct in the scale. This study was replicated by Soyer et al (2001) with these studies being extended further through examination of the NPI divergent validity. NPI was seen by this study to have a validity construct that was high; not of covert narcissism but of overt narcissism. Other narcissism measures however contained a higher convergent and construct validity for the convert narcissism assessment (Soyer et al, 2001). NPI was not seen to measure narcissism but was rather seen to be related in a positive way to the achievement need. Samuel and Widiger (2008), highlights that there is no narcissism measure that has entirely been conclusive or even have the ability of measuring the narcissism accurately across the orientations that are theoretical. They claim that this conundrum is as a result of operational definition multiplicity that shoots from each of the theoretical orientation. For instance, the TAT narrative is used by the Social Cognitive and Object Relations Scale for measuring specific personality disorders therefore not capable of being used in the analysis of the behavioral orientation. The DSM-IV TR criteria primary based instruments further more are only able to measure the narcissism characteristics that are external with an inclusion of exhibition and grandiosity and the correlation with vulnerability, depression and sensitivity is not positive. However, through other measures that are based on the five factor model, the destructive effects of narcissism can be measured.

According to studies conducted with the Five Factor Model in relation to narcissism, there is a perception of having the ability of giving a picture that is more complex and complete in relation to measuring the other manipulation, lack of empathy as well as measuring the narcissism convert form. In other studies, there has been a confirmation that the NPD instrument that is based on the FFM is perceived to measure NPD more adaptable form than it has been expected previously (Miller and Campbell, 2008). According to the findings, it has been found that the NPD infected people usually tend to load high on the extraversion factors and on the agreeableness, it has been seen to be low (Lynam and Widiger, 2007).

According to a study that was recently conducted by Gunderson (2001), ways of definition of narcissism were found out that were beyond the Five Factor Model. The Five Factor Model empirical soundness is supported by Gunderson (2001) although the SWAP 200 has been seen to provide a data that is highly complex on the personality traits that have not been found in the Five Factor Model. Further argument is held that since there is a self administration of the Five Factor Model, the truth burden completely relies on the source from which the information is gotten.

Research recommendations

            Understanding narcissistic disorder is complex based on the fact that this kind of disorder is more of personality than physical. The assumption is most likely with most of these patients denying accepting the fact that there is indeed an abnormality in them. In addition, the validity of new measures for narcissism has to be ascertained; which will display a high overall reliability rate. Further more, there is a strong urge are more studies are carried out with an aim of ensuring the conclusion validity and reliability in addition to determining the true cause of this personality disorder, which is yet to be clearly determined.  This study forms the basis for analysis through which the mystery behind the narcissistic personality disorder can be unfolded.

 

 

 

 

 

 

 

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC

Coid, J. W., (1999). A etiological Risk Factors for Personality Disorders. British Journal of Psychiatry. 174: 530-538.

Davis, Roger D.; Millon, Theodore., (1999). Oxford textbook of psychopathology. Oxford University Press, New York, NY, US xii, 732pp.

Freud, Sigmund, Stracey, James, and Gay, Peter (1990). W.W. Norton &Co., The Standard Edition NY/NY, US.

Gunderson, J. G., (2001). Differentiating Narcissistic and Antisocial Personality Disorders.” Journal of Personality Disorders 15: 103-109.

Jang, K.L., W.J. Livesley, P.A. Vernon & D.N. Jackson. (1996). Heritability of personality disorder traits: A twin study. Acta Pschiatrica Scandinavica 94, 438-444.

Lynam, Donald R.; Widiger, Thomas A. (2007). Using a general model of personality to understand sex differences in the personality disorders. Journal of Personality Disorders, v. 21 issue 6, p. 583-602.

Miller, Joshua D.; Campbell, W. Keith. (2008) Comparing clinical and social-personality conceptualizations of narcissism. Journal of Personality, v. 76 issue 3, 2008, p. 449 476.

Rathvon, N., & Holmstrom, R. (1996). An MMPI-2 portrait of narcissism. Journal of Personality Assessment, 66, 1-19.

Ronningstam, E., (2005). Identifying and understand the narcissistic personality.Oxford University Press, New York, NY, US. xiv, 239pp.

Samuel, Douglas B.; Widiger, Thomas A., (2008). A meta-analytic review of the relationships between the five-factor model and DSM-IV-TR personality disorders: A facet level analysis. Clinical Psychology Review, v. 28 issue 8, 2008, p. 1326-1342.

Schore, A. (1994). Affect regulation and the origins of the self. Hillsdale, NJ: Lawrence Erlbaum.

Simon, R., (2002). Distinguishing Trauma-Associated Narcissistic Symptoms from Post-Traumatic Stress Disorder: A Diagnostic Challenge. Harvard Review of Psychiatry 10: 28-36.

Soyer, R.B. Rovenpor, J.L. , Kopelman, R.E., Mullins, L.S., Watson, P.J. (2001). Further Assessment of the Construct Validity of the Four Measures of Narcissism: Replicatio and Extension. Journal of Psychology, 135(3) 245-258.

Watson, P. J.; Sawrie, Stephen M.; Greene, Roger L.; Arredondo, Rudy., (2002). Narcissism and depression: MMPI-2 evidence for the continuum hypothesis in clinical samples.” Journal of Personality Assessment, v. 79 issue 1, p. 85-109.

 

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