Narcissistic Personality Disorder . Narcissistic Personality Disorder , as described by the DSM-5-TR , is a pervasive pattern of grandiosity in fantasy or behavior , as well as a need for admiration and a lack of empathy that begins in early adulthood . This occurs in a variety of contexts and has at least five indicators out of the nine that are listed in the DSM-5-TR .
These individuals tend to devalue others for their imperfections . At times they may idealize others whom they feel meet their criteria for perfection , only to be disappointed when the idealized figure ultimately fails or lets them down in some way .
Grandiosity is the most useful feature in differentiating narcissistic personality from histrionic , antisocial or borderline personality . Excessive pride and a lack of emotional expression may distinguish narcissistic from histrionic personality .
A fairly stable sense of self , lack of self-destructive and impulsive behavior and abandonment concerns may distinguish narcissistic from borderline personality . These individuals are often extremely vulnerable to fluctuations in self-esteem , rage and depression if slighted or if they feel that they have been rejected of defeated in some way .
Depression is often the reason for seeking psychotherapy after some such disappointment has occurred . While individuals with narcissistic personality disorder may be quite arrogant , others may hide their sense of superiority behind humility and self-sacrifice .
The theoretical approaches applied with this disorder are cognitive , behavioral , interpersonal and psychodynamic psychotherapy For deeper changes . A more dynamic and longer-term approach is useful . The goals for CBT treatment should be to find new ways to maintain self-esteem , increased sensitivity toward others , improved problem-solving and increased self-awareness .
Psychodynamic psychotherapy is considered in some circles to be the treatment of choice for these individuals . Self-psychology , originally developed by Heinz Kohut , seeks to empathize with the individual's hurts and disappointments . This mirroring and allows the development of an idealizing transference .
Empathic breaks or failures in empathy are inevitable and provide an opportunity for reparation of these breaks . The pattern of disappointment and repair allows the client to become aware of his or her sensitivity to disappointment and to internalize the imperfect but sensitive other of the therapist .
Interpersonal therapy is a short-term approach to help the individual to gain deeper understanding of the issues that prevent deeper intimacy in relationships . The approach allows the client to gain more empathy for others and gain a more realistic view of relationships , thereby improving social support .
The clinician must be cautious , whatever the approach , not to confront interpersonal deficiencies or lack of empathy too soon . The individual may have come to therapy because of depression that resulted from disappointment and feelings of defeat .
One must be cautious to rebuild the individual's self-esteem and develop a working alliance before confronting the deficits that create their interpersonal problems . Further mirroring behavior on the part of the therapist will undoubtedly bring out the arrogant behavior that is their pattern .
One must be careful in their own response to the interpersonal defects that create difficulties in most other relationships , while still maintaining a broad perspective , conduct an assessment and address any safety issues . You will also need to establish a therapeutic relationship so you can motivate them for treatment .
A thorough clinical history and psychosocial will be needed . A personality assessment may be useful . Now that we've covered the basics of narcissistic personality disorder , let's go over a final summary of different theoretical approaches used in treatment .
Schema therapy is often considered highly effective for personality disorders , including narcissistic personality disorder , because it directly addresses deep-seated maladaptive schemas that drive narcissistic behaviors . It combines cognitive , behavioral and experiential techniques , making it a comprehensive approach .
Transference-focused psychotherapy is specifically designed for treating personality disorders , particularly those in the Cluster B category , which includes narcissistic personality disorder . It uses the therapist-client relationship to explore and modify the client's dysfunctional interpersonal patterns .
Cognitive behavioral therapy is effective for addressing the cognitive distortions and behaviors associated with narcissistic personality disorder . It's widely used and adaptable , but may not go as deep into the personality structure as other therapies like schema therapies , psychodynamic therapy .
While traditional psychodynamic therapy can be effective , it tends to be more long-term and may not always engage individuals with narcissistic personality disorder , who often struggle with introspection and the therapeutic process . However , when tailored to narcissistic personality disorder , it can address underlying issues effectively . It's in there , you can do it .