Narcissistic Personality Disorder

Approaching Narcissistic Personality Disorder

Various types of personality disorders and mental conditions are the research and study objectives, and narcissistic personality disorder (NPD), which is the focus of Narcissism: A Redefinition and Case Study written by Heitler, is one of them. Sufficient knowledge on narcissism can be beneficial for comprehending the affected people, restraining them from actions that may aggravate the symptoms, and improving their condition. The named medical condition can drastically impair personal and social communication, interaction, and functioning; therefore, there is a need to identify the primary symptoms of NPD and analyze efficient treatment modalities to approach it in a proper manner based on the given case study.

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Overview of NPD

NPD belongs to the group of mental and personality disorders. It is characterized as comprising a pervasive pattern of grandiosity, a constant need for worship and admiration, and a reduced empathy toward the environment (Ambardar & Bienenfeld, 2017). In the research paper Narcissism: A Redefinition and Case Study, Doctor Heitler (2014) identified NPD as a deficient bilateral listening that results in consequent deafness to others' concerns and needs. It can drastically jeopardize the health of the collaborative relationship. The etiological aspect of NPD remains unknown, though certain biological, psychological, social, and environmental factors hypothetically participate in the development of the discussed abnormality (Ambardar & Bienenfeld, 2017). Presently, scientists have not established any genetic precipitating factors, though further sophisticated research may provide insight into this issue as well. Furthermore, therapists developed object-related and self-psychology etymological theories that can be beneficial for comprehending and managing narcissism in the future. Otto Kernberg considered NPD as a consequence of inadequate and inappropriate maternal attitude toward the child, which makes one internalize a feeling of self-grandiosity and decrease emotional sufferings in such manner. According to Heinz Kohut, the described disorder results from a person's developmental arrest in combination with significant comorbid psychological and cognitive impairments (Ambardar & Bienenfeld, 2017). Thus, deficient parenting prevents a child from apprehending oneself in the society and accepting the reality, which eventually induces a person to seek love and admiration from others. The deficit of attention, appreciation, and love relate to the first clinical manifestations of this medical disorder.

Symptoms and Signs of NPD

Narcissism can be revealed due to the presence of various psychological impairments such as a hypertrophied, pathological sense of own self-grandiosity and importance, confidence in own unicity, and insufficient empathy. Eleanor Payson, the author of The Wizard of Oz and Other Narcissists, identified people with NPD as individuals with a primitive, undeveloped sense of self, malignant anxiety, and emptiness, which they are eager to compensate by creating a grandiose image and demanding admiration, worship, and obedience (Yoffe, 2009). Furthermore, arrogance, superiority, disdain, criticism, intolerance, craving for appreciation and admiration, dismissive responses, excessive entitlement, and tendency to overvalue appearance are distinct hallmarks of the reviewed medical disorder (Heitler, 2014). Individuals afflicted with NPD are frequently envious and preoccupied with own fantasies, power, beauty, and brilliance. They frequently demonstrate and involve obvious interpersonally exploitive, manipulative, or defensive behavioral patterns. They prefer taking advantage of others for achieving personal gains and goals, as well as feel obsessive in pursuing objectives and blaming others for being incompetent or hostile in case goals are not achieved (Dimaggio, 2012). It is habitual for them to make somebody guilty or faulty for personal failures or flaws.

Narcissistic people can scarcely tolerate critical statements addressed to them. They are hypersensitive and internally vulnerable to being insulted, criticized, compromised and underestimated. Therefore, they choose either defense or attack to protect their fragile and atrophied ego. They frequently choose an aggressive, angry, and furious response to the contradictory thoughts of the opponents. Some of the afflicted persons may react to criticism or frustration with bouts of rage, humiliation, or embitterment (McCance & Huether, 2014). Thus, the diversity of symptoms relating to narcissism sustains the complexity of the studied disorder. Furthermore, the outlined symptoms can be viable for the case research.

Treatment Options for Managing NPD

NPD is considered one of the most difficult personality patterns to treat due to the reluctant involvement or disinterest of patients in the treatment process (McCance & Huether, 2014). Practicing psychotherapists and psychologists have developed certain treatment modalities appropriate for alleviating and managing NPD. Such psychotherapeutic techniques as individual, group, family, and couples therapy, cognitive-behavioral and short-term objective-focused psychotherapies, and conflict-solving strategy are involved in various cases.

In the given case, such possible treatments as psychodynamic and cognitive therapies are possible. Psychodynamic therapy is designed to assist in recognizing and functioning despite mental insecurities, whereas the cognitive one is prescribed for redirecting patient's attention to the opinions and emotions of others. It is beneficial for cultivating empathizing ability and altering all-or-nothing behavioral principles in NPD-affected people. Active involvement of the stated psychological techniques in individual or group sessions can be productive.

Individual and group therapies are other possible treatments for the case. Individual therapy can help NPD patients to undergo character transformation and maturation, which involves the acquirement of empathetic capacities, a sense of humor, tolerance, and wisdom. Such sessions help NPD people to acknowledge personal disadvantages and the roots of the problem. It is viable for the recognition and acceptance of personal actual competence and potentiality in NPD sufferers who eventually allow tolerating criticisms (Mayo Clinic Staff, 2014). On the other hand, group therapy assists in developing a healthy personality, transforming prior narcissists into people who start accepting others as equal to them and worthy of respect. It can be effective for improving social interconnection with the surrounding environment, maintaining personal relations, and comprehending somebody's feelings and emotions.

Other options include couples therapy and conflict-solving techniques. Couples therapy is focused on remediation of listening patterns that can considerably reduce narcissism and heal personal and relationship distress (Heitler, 2014). Trustworthy, sympathetic, and respectful relationship between the client and the therapist can be productive and efficient for achieving positive outcomes. Conflict-solving techniques are designed for finding resolutions in conflictual situations, avoiding them, and reducing the force of confrontations. All of the above psychotherapeutic techniques are beneficial for the achievement of treatment goals. The outcome of the applied therapies can improve personal and social communications and diminish narcissistic traits.

Case Study

The present case deals with a married couple, Mark and Joan, who are 35 and 33 years old, where one of the spouses suffers from NPD while his wife exhibits depressive symptoms and distress. The couple sought psychological assistance to improve family interconnection. Identified psychological impairments specific for NPD considerably affect personal relationship, as well as Mark's attitude to his wife, who overreacts to his reduced empathy and self-centered attitude to her. The practical therapist evaluated the provoking factors and causes of multiple spousal conflicts. In the course of the case study, such narcissistic traits as self-importance, reduced empathy, deficient attention to others, domination of his personal interests above the family ones, deafness to his wife's concerns and requests, and dismissive responses to her were revealed in Mark, which impacted normal communication within the family. Moreover, overreaction or hypersensitivity to being criticized and fear of being underestimated are tightly linked with aggravated personal relationship. Mark was unable to pursue win-win solutions to conflict situations that were a trigger for the misbehavior of both. In the course of treatment, the causes of Mark's behavior became evident, namely deficient appreciation from Mark's parents, permanent inability to solve a problem in a calm, productive, and respectful manner, as well as aggressiveness and rage that dominated in his parental house. Deficient listening in his childhood promoted his deafness to others in maturity.

Treatment provided by Doctor Heitler assumed the conduction of three talk sessions of couple therapy with the involvement of various behavioral therapeutic techniques such as coaching listening skills, coaching exit or re-entry routines for anger management and zero fighting, constructing appropriate dialogues with starting sentences I feel or I am concerned, addressing personalizing and conflict-solving therapy. All of the methods were designed for improving bilateral listening, decreasing narcissistic traits and habits in Mark, developing empathic capacity, and making dialogues more sufficient with problem-resolving content. The therapist taught Mark and Joan to avoid the confrontation and arguing by leaving a room and rejoining it with a positive mind. She gave a lesson that constructive mind and not destructive thoughts and mood are vital in stressful situations. Common sense is beneficial for searching ways out instead of approaching relationship deadlock. Furthermore, the talk sessions helped in Mark's comprehension and recognition of personal demerits and the roots of his vulnerable ego that went back to his childhood.

The outcome of the conducted therapeutic interventions was beneficial for the couple due to the obvious transformation of dismissive listening into the responsive one, the acquirement of anger-managing skills, reduced criticism and blaming, the replacement of fighting with problem-solving, and sufficient sharing of affection and appreciation (Heitler, 2014). The comprehension of childhood roots of Mark's narcissistic traits and the behavioral transformation of the couple assisted in improving the personal relationship between the spouses and securing family for the future.

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NPD is specified as one of the personality disorders with such symptoms as exaggerated personal importance or grandiosity, inappropriate attitude and behavior toward others, self-concentration, intolerance of criticism, and inappreciation. This medical disorder can drastically preclude from healthy and normal social and personal functioning and interaction. The variety of psychotherapeutic methods and techniques, including individual, group, and couples therapy, conflict-solving strategies, as well as psychodynamic and cognitive therapy, can be efficient for achieving considerable changes and improvements.

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