Psychiatr. pro Praxi, 2005; 1: 18-25

NARCISSICTIC PERSONALITY DISORDER - DIAGNOSIS AND TREATMENT

Mgr. Petra Houbová¹, doc. MUDr. Ján Praško CSc^1,3,2,4, PhDr. Marek Preiss¹, MUDr. Erik Herman^5,7,6

¹ Psychiatrické centrum Praha, 3. LF UK, Praha

² Centrum neuropsychiatrických studií, Praha

³ Psychiatrická klinika FN a LF UP, Olomouc

⁴ 3. LF UK, Praha

⁵ Psychiatrická klinika 1. LF UK a VFN Praha

⁶ Neurologické oddělení, neuropsychiatrické a epileptologické centrum, Nemocnice Na Františku s poliklinikou, Praha

⁷ Psychiatrická ambulance, Praha

Narcissistic personality disorder is a pervasive pattern of grandiosity, need for admiration and lack of empathy. Persons with narcissistic personality disorder can be very vulnerable to threats to their self-esteem. They may react defensively with range, disdain, or indifference but are in fact struggling with feelings of shock, humiliation, and shame. Narcissism may also develop through unempathic, neglectful, and/or devaluating parental figures. The child may develop the belief that a sense of worth, value, or meaning is contingent upon accomplishment of achievement. Parents failed to adequately mirror an infant’s natural need for idealization. Other possibility is that infant received excessive idealization by parental figures, which incorporated into self-image. Conflicts and deficits with respect to self-esteem have been shown empirically to be central to the pathology of narcissistic personality disorder.

Persons with narcissistic personality traits seek treatment for feeling of anxiety, depression, substance-related disorder, and occupational or relational problems that are secondary to their narcissism. It is difficult for them even to admit that they need help, as this admission is itself an injury to their self-esteem. They also belief that they can only be understood by persons of a comparably high social status or recognition. Psychodynamic approaches to the treatment of narcissistic personality disorder vary in the extent to which emphasis is given to an interpretation of underlying anger and bitterness, or to the provision of empathy and a reflection (or mirroring) of a positive regard and self-esteem. It does appear to be important to identify the current extent and historical source of the conflicts and sensitivities regarding self-esteem. Active confrontation may at time be useful, particularly when the therapeutic alliance is strong, but at other times the vulnerability of the patient may require a more unconditional support. Cognitive-behavioral approaches emphasize increasing awareness of the impact of narcissistic behaviors and statements on interpersonal relationships. The idealization and devaluation can be responsive to role playing and rational introspection, an intellectual approach that may itself be valued by some persons with narcissistic personality disorder. Group therapy can be useful for increasing awareness of the grandiosity, lack of empathy, and devaluation of others.

Keywords: Key words: Narcissistic personality disorder, grandiosity, vulnerability, diagnosis, etiology, psychodynamic approach, cognitive-behavioral therapy, group therapy.

Published: February 1, 2006  Show citation