Narcissistic Personality Disorder

Narcissistic Personality Disorder is triggered by a combination of biological and social factors. Behavioral genetic studies of NPD, like studies on twins who did not grow up together, show that genes markedly the personality disorders “emotional” cluster, including NPD (Torgersen, 2000). If this disorder is strongly linked with genetics, individuals are not likely to develop NPD without first having a trait profile that makes them vulnerable to this disorder. (Paris, 2014)

The social causes are in link with two environments: the family the child grew up in (early socialization) and the society’s culture. A longitudinal study on children found that narcissism can be due to parental overvaluation and not by lack of parental warmth. NPD can be cultivated by an early socialization experience with the point of view of the parents. However, this same study shows that self-esteem is cultivated by parent warmth and not overvaluation. NPD is therefore caused by a certain way of raising a child. NPD takes roots during childhood: some teenagers may appear like having the disorder, but it is just part of the lifespan developmental process. (Brummelman, 2015).

Since narcissism is a necessary condition for NPD, any factor that increases the probability of narcissism also increases the risk of the disorder. The recent (XIXth, XXth centuries) phenomenon of individuality increased the society’s raise of narcissism. People that cannot easily adapt to a society’s way of life may fall into extremes. Another university research on students, measured with a test of narcissistic personality, has shown that this trait has increased over time. The study indeed compares results with other historical periods such as 30 years ago and finds that contemporary subjects were more likely to have high scores. (Paris, 2014)

Symptoms and diagnosis criteria

For a patient’s disorder to be recognized as the Narcissistic Personality Disorder, at least five symptoms have to be corresponding to the following criteria. The DSM-V describes the NPD in nine diagnosis criteria, that can be clustered in three groups. Firstly, grandiosity is an important symptom of the disorder. The three first criteria describe a grandiose sense of self-importance (exaggerating achievements and talents and devaluation of contributions of others), a preoccupation with idealized power, fantasies of success and brilliance. The patients believe that they are unique and should only associate with persons that they consider of high status.

The two following criteria involve the need of admiration: a person with NPD requires excessive admiration and a sense

of entitlement (unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations). Finally, a person with NPD has a strong lack of empathy. They are interpersonally exploitative to achieve their own ends and lack empathy in the sense that they are unable to identify other people’s feelings and needs. They are often envious of others or think others envy them and show arrogant behaviors.  (APA, 2015)

BULLET POINTS: grandiosity, need for admiration, lack of empathy

Therapy and medication

A few therapy techniques first developed to help borderline personality disorders were adapted to narcissistic personality disorder. Two psychodynamic treatments are available. The mentalization-based therapy helps to accurately self-reflect and reflect on others’ thoughts and feelings (and to link these mental states with behaviors). The schema-focused therapy, that links psychodynamic with behavioral therapy, helps to replace unhealthy schemas: persistent negative perceptions of the self and others. A form of cognitive behavioral therapy, called dialectical behavior therapy, focuses on emotional regulation and mindfulness (acceptance of the disorder helps to recognize the behaviors linked to it).

Finally, the metacognitive interpersonal therapy was specially developed to treat NPD. It includes stage setting, which consists in exploring different situations and recurrent patterns to gain a deeper understanding of the person’s relationships. Change promoting consists in showing different points of view and angles of comprehension of a situation, so that the person can gain in empathy. (Tartakovsky, 2019) Specific medication for NPD does not exist, but medication such as mood stabilizer, antidepressant or antipsychotic can be used when NPD’s symptoms compromise one’s safety (impulsive anger or aggression). (Tartakovsky, 2019)