Is Psychotherapy Effective for Narcissistic Personality Disorder?

Narcissistic personality disorder is a mental disorder which affects around one percent of the world’s population. It happens to appear more often in men than women and affecting the juveniles more than older people. Those people who have this condition is characterized by having an inflated sense of their own importance, a deep need for excessive attention and admiration, troubled relationships, and a lack of empathy for others. The hallmark description of narcissistic personality disorder is gaudiness – the exaggerated sense of grandiosity.

Those affected often spend much time thinking about achieving power or success, or on their appearance. A person with narcissistic personality disorder causes conflicts in many extents of life, such as relationships, work, school or financial matters. Narcissists may be generally unhappy and disappointed when they’re not given the special favors or admiration they believe they deserve. They tend to have difficult relationships, and other people surrounds them may have a hard time coping up with them.

They are identified due to their lack of humanity towards the world and towards other people, a narcissist becomes his own world and believes the world is him. When the power of superiority fades away, they will be conscious, allowing their sense to feel sadness and loss, by then they’re awaken by reality. They’d be regretting spending their life proving others that they’re successful, powerful, intelligent and whatsoever instead of really enjoying the beauty of life.

4.2 Signs and Symptoms

Narcissistic personality disorder usually develops in adolescence or early adulthood.

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Its symptoms must be severe that they knowingly damage the person’s capabilities to develop meaningful and sincere human relationships. Generally, the symptoms of NPD also harm the person’s psychological abilities to function, either at his workplace, school, or important social settings. There are a lot of signs and symptoms of people with narcissistic personality disorder, it is visible, and sometimes predictable.

4.2.1 Grandiose sense of self-importance

Grandiosity refers to an unrealistic sense of dominance, a constant view of oneself as better and powerful than others. It is the defining characteristic of narcissism. Narcissists believe they are remarkable or “special” and can only be understood by other special individuals. Likewise, they are too good for anything normal or ordinary. They only want to relate and be associated with other high-status individuals, spots, and things.

Aside from believing themselves that they’re better than anyone else, they also expect recognition even if they did not work hard to earn it or even if they don’t really deserve it. They often love to exaggerate their accomplishments in life, skills, experiences and talents. When the conversation’s topic is about work or relationships, of course the center of the topic will always be them, they will often tell others how much they contribute and how lucky the people in their lives are to have them.

4.2.2 Lives in a fantasy world that supports their delusions of grandeur

Narcissists live in a fantasy world sustained up by distortion, self-deception, and enchanted thinking, since reality doesn’t support their grandiose view of themselves. In the fantasy world where unlimited success, power and perfect love that make them feel extraordinary and in charge of everything. These fantasies serve as a shield to protect them from feeling of humiliation and inner emptiness so that’s why the facts and opinions that counters them are ignored. Whoever dares or threatens to burst the fantasy bubble will encounter their extreme defensiveness and even rage.

4.2.3 Needs constant praise and admiration

The occasional compliment is not enough. A narcissist’s sense of dominance is like a balloon that gradually loses air without a stable stream of praise and recognition to keep it inflated. They need constant food for their ego, so they surround themselves with folks who are willing to cater to their obsessive craving for affirmation so that they will be full. These relationships are very one-sided. It’s all about what the admirer can do for the narcissist, never the other way around. And if there is ever a disturbance or diminishment in the admirer’s attention and praise, the narcissist sees it as a betrayal.

4.2.4 Sense of entitlement

Since they are known for considering themselves as special, narcissist expect favorable treatment as they pleased. Their motto in life is that whatever they want, they believe they should have it. They also expect other people around them to have the initiative to follow their wishes. Then if a certain person failed to comply their demands, then they think that person is useless. If people have the guts to defy their selfish will, then they will witness the narcissist’s outrage and aggression.

4.2.5 Exploits others without guilt or shame

One thing that narcissists never developed is that the ability to put themselves on someone’s shoes. The lack empathy, they cannot recognize the feelings of others, for them, other people are just objects in the world, the purpose of their existence is to serve their needs and wants. The only thing that is important to them is their own needs. They are inconsiderate and insensitive, they merely don’t think about how their behavior affects others.

4.3 Causes of Narcissistic Personality Disorder

In detecting the causes of Narcissistic Personality Disorder to develop, professionals tend to apply a Bio psychosocial Model of Causation. The model was proposed by George L. Engel to better study the development of disorders through the complex interaction of biological factors (genetic and biochemical), psychological factors (mood, personality, and behavior), and social factors (traditional, familial, socioeconomic, medical, and etc.)

4.3.1 Environmental Causes: Parenting Styles

Parenting styles and family dynamics are especially critical to a juvenile’s emotional and psychological health, and it is the latter factor in particular that seems to be decisive in the beginning of narcissistic personality disorder during adulthood. Most of the focus in assessing a research based on environmental factors are inevitably on childhood experiences, which set a template for future mental health and personality development. Childhood experiences molds you to become who you are today, your attitude, your behavior and such. Based on research findings, experts have identified three types of ineffective parenting that are heavily contributed to the development of NDP.

4.3.1.1 Authoritarian Parenting

Parents who adopt an authoritarian style are overly controlling, highly demanding, and slow to give approval. They lacked in giving affection to their child and they seldom trust their child and doesn’t give them a room to grow and correct their own mistakes. Mistakes tend to be punished harshly. They have very high expectations of their children, but provide very little in the way of a good feedback and nurturance.

Through this style, they are the cause why their children have low self-esteem and the ability to feel empathy for others. Strong demands produce highly insecure children, and as they mature they may develop narcissistic personality traits as a coping mechanism.

4.3.1.2 Permissive Parenting

Parents who are permissive tend to praise or pamper their kids ceaselessly, either as a way to keep them appeased or because they truly believe their children are special. They don’t set clear standards for their children to live up to, building confusion by offering lots compliments and attention without any limitation regardless of actual behavior or performance.

Relentless praise and permissive attitudes can lead to inflated egos in children, who grow up as adults believing they are right every time. On the other hand, if kids sense their parents won’t discipline them or establish limitations because they don’t care then their self-esteem may be damaged and they may adopt unsympathetic attitudes toward other people.

4.3.1.3 Pathological Parenting

People who are exposed to physical, emotional, and sexual abuse in childhood is a common factor for them to be diagnosed with mental health disorders, including those with narcissistic personality disorder. One of study reported on by the Journal of Personality Disorders in the year of 2007, people who’d experienced extreme abuse and mistreatment in childhood were 2.93 times more likely to be diagnosed with NPD than members of the general public.

4.3.2 Genetic Causes

Childhood experiences are known to be vital to the development of narcissistic personality disorder. However, there are also genetic factors involved that create a greater vulnerability for the disorder. NPD is unlikely to develop unless environmental causes are unusually strong. Children with Narcissistic Personality Disorder may be inherited the characteristics of their parents.

4.4 Treatment for Narcissistic Personality Disorder

There are a lot of ways or treatment in curing Narcissistic Personality Disorder. Although treatment for narcissistic personality disorder is quite difficult, these methods or ways are effective in assessing the patients. These methods have its own way of diagnosing their patients, and has its own different forms of diagnosis.

4.4.1 Shedler-Westen Assessment Procedure-II

Shedler-Westen Assessment Procedure-II or also known as SWAP is a psychological test to assess the personality of the mentally-ill people. Patients do not interact with SWAP, for the diagnoses is done by their clinical observations. So, they provide self-report questionnaires that allows the patient to describe themselves.

By the result of self-report questionnaire, clinicians provides detailed psychological descriptions of the patients by the scores that their patients have during the assessment. Based on the checklist, it has been reported that a total of 255 patients met DSM-IV criteria for narcissistic personality disorder and 122 patients were reported based on the construct ratings, and 101 patients encompasses by both methods. They have dug deeper towards observing the real traits of a person with NDP, and they have concluded that they do not only feel the inflated sense of self-importance, grandiosity, and such but what they have discovered is that they have painful insecurity towards one’s self, interpersonal vulnerability, and the feeling of fraudulence.

4.4.2 Interpersonal diagnosis

Intrapersonal diagnosis is a treatment used to assess the patients and their families in a way that their therapists find specific ways to help them cope up with their relationship towards one another. Dr. Benjamin believes that a type of relationship within the family that a person plays a vital role in molding his behavior. If a person lives with a toxic family, there is a possibility that he will be influenced by his family, living in the world with a toxic behavior.

This treatment involves interviews, treatment interventions, and diagnostic processes. It also provides counseling towards the families who have a family member with a narcissistic personality disorder. They will explain to them why the disorder happened or occurred, in order for them to open up their eyes, in order for them to realize and to regret for what they have done that has been contributed to the occurrences of the mental disorder towards their family member. Since childhood experiences can result to narcissistic personality disorder. The goal of this method is to help the patient to build up his life again by assisting him to reconnect with his family, building a sincere and loving bond, taking away the feeling of anger, fear, and subjugation.

4.4.3 Psychoanalysis Theory

Psychotherapy is the most effective way, paired with medication if necessary. It was proposed by Sigmund Freud, the father of psychoanalysis. This treatment is done by talk therapy, for it is done by interchanging of words between the patient and the analyst. The doctor will ask the patient what he really feel, asks him if he’s aware of his condition, and asks him his childhood experiences. Through the information that the doctor has gathered, he will then explain to him his condition, and the reason for its occurrences, the doctor will suggest ways to mold the behavior of his patient to become better, in order to slowly cure the patient’s disorder. It helps the people with NDP learn to socialize better with others so their relationships will become more intimate and pleasant.

Through this technique, they will be able to understand and to comprehend reasons behind of their emotions and what drives them to compete, to question others, and perhaps to despise themselves and others. The therapy can be short term to help them manage during times of stress or crisis, or can be given on a progressing premise to enable them to accomplish and keep up their objectives. Every now and again, including relatives or critical others in treatment can be useful.