Treatment Issues

Narcissistic Personality Disorder

Narcissism is excessive self-involvement, vanity, egocentrism, and lack of regard for others. While most people display narcissistic traits from time to time, when narcissism is a person’s primary method for coping with the world, he or she may be diagnosed with narcissistic personality. Narcissism is named for the Greek myth of Narcissus—a man so vain that he spent his life staring at his own reflection in a pool of water.

There are a wide variety of symptoms associated with narcissistic personality, and not all people will show all symptoms. People with narcissistic tendencies are outwardly egocentric, but often suffer from a fractured sense of self or chronically low self-concept. In extreme cases, narcissism can result in sociopathic behavior. The condition is significantly more common in men than in women.

The Diagnostic and Statistical Manual (DSM) suggests a diagnosis of narcissistic personality disorder (NPD) when a person's functioning is impaired by the following symptoms:

• Preoccupation with fantasies of extreme success, power, or fame
• Constant need for admiration and affirmation
• A strong sense of entitlement
• Envy of others, particularly their achievements, or believes that others should envy him or her
• Inflated sense of self-esteem; megalomaniacal tendencies
• Belief that he or she is special or unique
• Setting unrealistic goals
• Exploitation of others
• Difficulty maintaining healthy relationships
• Lack of empathy or ability to take responsibility for behaviors
• Cannot tolerate criticism

People with narcissistic tendencies are highly sensitive to rejection, but largely unsympathetic to others' emotions. A relationship with someone who has narcissism often means providing extensive emotional support and coping with erratic and unpredictable behavior, all while receiving little emotional support in return. This makes a relationship with such a person a challenging endeavor that can undermine the self-esteem and confidence of people involved with those who are narcissistic. A number of online forums and support groups are dedicated to helping people cope with or leave narcissistic relationships.

People with narcissistic tendencies can be charming and manipulative, potentially offering them advantages in the workplace. People who work with someone who has narcissism, particularly when that person is a boss or superior, may feel intimidated or manipulated. Some people who are narcissistic may engage in workplace harassment or bullying, while others feel little remorse about lying or otherwise harming others to get ahead at work.

Narcissism is still not well understood, and psychologists are unsure of the precise cause of narcissism. Treatment typically focuses on addressing any experiences that have contributed to these problems.

Many treatment providers embrace a biopsychosocial model that emphasizes the role of three unique but inseparable influences: Biological causes: Narcissism could be due to differences in brain chemistry or genetics, and there's some evidence that it runs in families. Importantly, early experiences can change the brain, so it's possible for early environmental experiences to produce biological differences that contribute to the development of narcissism.

Psychological causes: Psychological causes of narcissism include an individual's temperament and personality. Some research suggests that narcissism could be due in part to a belief that it is unacceptable to show vulnerability.

Social causes: People with narcissistic parents are more likely to develop narcissism themselves. This could be due either to genetic factors or to early learning. A variety of other social learning theories have emphasized the role of abuse and neglect, unreasonably high parental expectations, trauma, a lack of early discipline and rules, or learning manipulative behaviors from others.

Narcissism is notoriously difficult to treat, particularly because people with narcissistic personality have trouble seeing themselves as flawed. In my practice I often focus on teaching empathy and life skills, and focusing on specific problematic symptoms. For example, when a person’s narcissistic tendencies cause periods of rage or resentment, I will help a person institute better coping strategies. Medication can be helpful for mitigating some symptoms, and I often refer my clients to a psychiatrist I closely work with as we may decide that prescribing medication may be warranted and helpful. Medications may range from antidepressants to antipsychotics, depending upon specific symptoms.

If you or someone you love is struggling with narcissistic traits or behaviors, Please contact me at 415-454-8931 or [email protected]

If you like what you have read, and you think I could help, please call or email me for a free consultation at 415-454-8931 or [email protected]