Causes and Description of Narcissistic Personality Disorder - Essay Example

?Running Head: PERSONALITY DISORDER Narcissistic Personality Disorder Outline I Introduction II. Body A. Narcissistic Personality Disorder 1. Definition 2. Causes A. Case Study 1. The Case 2. Mental Status Exam 3. DSM-IV Multiaxial Evaluation B. Treatment 1. Pharmacological Treatment 2. Generics and Trade Names 3. Side Effects II Summary A. Stress B. Relationship to Practice C. Summary Narcissistic Personality Disorder Introduction Some personality disorders, while intrusive into an individual’s life, do not seem to be a problem in that they often support success. Narcissistic personality disorder has features that can sometimes support success, but are without the control that someone who was not afflicted with a disorder would assert. There is a difference between having narcissistic tendencies and having a disorder. The narcissist will have the belief of aggrandized importance, but someone with the disorder will have deluded beliefs associated with that sense of importance. The narcissist beliefs that they are the center of the world and that all else exists solely for their purposes. When those beliefs are challenged, the results can be cataclysmic. Individuals with narcissistic personality disorder believe that they are in the center of the world and that it exists only for their ends, with no consideration or empathy for anyone else. Narcissistic Personality Disorder Narcissistic personality disorder is a part of the Cluster B types of personality disorders and is defined as a dramatic and emotional form. A person with this disorder will exaggerate their own importance, will not have much feeling in regard to the plights of others, will be self-obsessed, and will seek power and accolades for their achievements and might be disappointed when others do not show them a high appreciation for even their smallest accomplishments. The Narcissist is completely consumed with themselves. Most of that which is pursued by a narcissist will involve themselves and not include the needs of others in their decision making processes. Because of this self obsession, a narcissist will have difficulty keeping healthy relationships as others are not often a part of their decision making process, thus disallowing for their needs and keeping them set apart. These individuals do not take criticism well, but will use verbal abuse to make others feel very small in their presence (Ronningstam, 2005). Freud referred to narcissism as “the choice of self as a libidinal object” in which the sexual development of the individual is then perverted (Ronningstam, 2005, p. 6). Narcissism is often associated with someone being ‘evil’ as they behave without consideration for anyone else around them. Self-gratification is at the core of their actions. They will often believe that the rules do not apply to them and that they can act according to however they wish without regard to social norms. In contrast to those with borderline personality disorder who feel that they deserve special treatment because they have more needs, the narcissist feels they deserve more simply because of their inflated self importance and would consider the idea of being needy as humiliating (Gunderson & Links, 2008). Reactions that a narcissist will have can be extreme, such as the example given by Gunderson and Links (2008) where a young man who has inflated his importance as a budding young poet commits suicide because his girlfriend makes plans to move to another city and because he has tied his fantasy of importance to her, the humiliation is too much for him to endure. Often a narcissist will attach themselves to a mate who ladles on accolades and reinforces their belief in their self-importance. When that individual leaves, their condition can become volatile. One of the primary theories about narcissistic personality disorder is that while infants are born self-centered, it is during socialization that they learn to become empathetic through the empathies of their parents. If the child fails to learn how to empathize there is a profound failure in socialization that creates a narcissistic pattern of behavior. The child becomes “fixated at a self-centered, grandiose stage of development” (Durand & Barlow, 2010, p. 458). There are theories that suggest that Western culture is increasing the level of narcissistic tendencies as it is a “consequence of large-scale social changes, including greater emphasis on hedonism, individualism, competitiveness, and success” (Durand & Barlow, 2010, p. 458). The counter-argument is that the increase of the prevalence is due to an increase interest in identifying the disorder. Narcissistic personality disorder is often involved when events become lethal at a public level. Narcissism is often involved when someone kills another when they decide to kill themselves after killing a loved one who they believe could not survive without them. According to Daniels and Bradley (2011) psychopathic shooters are defined by narcissism which best describes the personality issues of the shooters at the Columbine High School shooting. Psychopathic shooters take pleasure in the pain that they inflict, and will lack a conscience about the actions that they have taken. Often times, the disorder will manifest in very negative ideas that include long periods of planning suicide that ends in the success of that plan. Narcissists will see others as there for their use, controlling those around them and while most often they commit no crimes as a result of their disorder, when they do it involves a lethal and final act (Durand & Barlow, 2010). There is a definitive difference between narcissistic personality disorder and a narcissistic personality style. A narcissistic personality disorder will manifest in delusions of grandiosity and an inability to succeed because of an expectation that they have already done as much necessary merely by existing. The disorder will create such rifts in relationships that they are almost impossible to maintain. Someone with the disorder might have a warped idea of what is happening around them, all references being associated with them. The world is designed for them without an understanding of how the needs of others relate on a scale of importance. A narcissistic personality style will have a better grasp on their world and will be willing to adjust, even though they have an inflated sense of their own importance. As an example, someone with a narcissistic personality style will believe that someone who gives them criticism is incompetent, but they will make changes in order to serve their own success. Someone with the disorder would be more likely to lash out and quit (Sperry, 2003). Case Study After six years of marriage, a man who is called Mr. C. has been diagnosed with narcissistic personality disorder is being threatened by his wife that she will leave him and at the same time he is being pressured by his place of employment to quit his job. Mr. C. buys very expensive suits because he believes that his position at work requires them even though they are well outside of their budget. He diminishes the importance of his wife and only seems to speak about her through terms that are relevant to his own needs. She feels that he loves himself far more than he could ever love her. At work they have notices very aggressive sales tactics that have bordered on the criminal. He uses scare tactics, exaggeration of the value of the product, and whatever other kinds of pressure he can muster because he believes that this is how he will become a millionaire. He believes that his company will go under without him and that he is too important for them to actually fire him (Sperry, 2003). A Mental Status Exam reveals that he is an overly well-dressed man with the effect of gathering all the attention onto himself when entering a room. He speaks very well and is able to convince others to fall into his delusions of self-importance when he needs them to follow his beliefs. Mr. C. becomes agitated when confronted with any challenge to his beliefs about himself and his coping skills do not include an ability to accept criticism, creating a sense of threatening behaviors when he feels criticized. He has a high level of intellectual function, even though he has an inability to access how those around him are responding to him. He is aware of his surroundings and there is no delusion about where he is and in what time frame the events are occurring. The primary DSM-IV-TR criterion for the diagnosis of narcissistic personality disorder is that there exists an inflated sense of self-importance. This disorder is classified in Axis II and must adhere to five of nine for a diagnosis. The criteria are as follows: has a grandiose idea of self importance, has a preoccupation with inflated levels of success, believes that they are unique and special and should only be involved with people of equal value, must have an excessive amount of admiration, believes they are entitled, takes advantage of others for their own needs, lacks empathy, is often envious, and displays a high level of arrogance (Sperry, 2003). Treatment Pharmaceutical treatment for narcissism is difficult because the disorder involves a myriad of symptoms that are delicate and unbalanced. Campbell and Miller (2011) suggest that some researchers are looking at narcissism as an addiction to the self, seeking out treatments that are focused on addiction therapy as a way of combating the problem. Drug therapies are almost non-existent in the search for a way to control the symptoms of the illness. One of the problems with the disorder is that there is a high level of anger, which can be controlled through anti-anxiety drugs. Xanax, a trade name for the generic form alprasolam, is one drug that can be used for such issues. Side effects for Xanax can be “Changes in appetite; constipation; decreased sexual desire or ability; diarrhea; dizziness; drowsiness; dry mouth; light-headedness; nausea; tiredness; weight changes” (Drugs.com, 2011). More severe symptoms can include “Severe allergic reactions; behavior changes; blurred vision; burning, numbness, or tingling; chest pain; confusion; dark urine; decreased coordination; decreased urination; fainting; fast or irregular heartbeat; hallucinations; loss of balance or muscle control; memory or attention problems; menstrual changes; muscle twitching; new or worsening mental or mood changes; overstimulation; red, swollen blistered, or peeling skin; severe or persistent dizziness, drowsiness, or light-headedness; shortness of breath or trouble breathing; suicidal thoughts or actions; tremor; trouble speaking; yellowing of the eyes or skin” (Drugs.com, 2011). Treatment for narcissistic personality disorder is approached most often through Beck’s cognitive therapy model. The therapy will focus on modifying behavior and teaching them how to respond others through empathy. Some problems can be observed through a natural resistance to the help that is being offered, skepticism that there is a need for the individual to change anything about themselves inspiring resistance to the suggestions that are being made by the therapist. Conclusion Stress is not a part of the disorder, but may be developed because of the disorder. The causes of the disorder are because of beliefs that the patient has developed because of his own sense of self. The rest of the world will not adhere to those beliefs, so he or she will develop stress as the world fails to meet his or her expectations. This will create anger and the results of that anger and frustration may turn lethal either to the patient or to others around them. In practice, the idea of narcissism and the ways in which to combat it would be a useful resource in looking at relationships. Relationships would be the first place that a narcissistic individual would have the most difficult as others fail to live up to their expectations. In practice, these individuals would likely poise a poisonous problem and addressing them through exercises that work towards building empathy would be beneficial to the couple or family as a whole. Pharmaceutical remedies do not seem to be effective. An individual with narcissistic personality disorder is consumed with the self which means creating a sense of others to combat the delusion. References Campbell, W. K., & Miller, J. D. (2011). The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings, and treatments. Hoboken, N.J: John Wiley & Sons. Daniels, J. A., & Bradley, M. C. (2011). Preventing lethal school violence. New York: Springer. Drugs.com. (2011). Xanax side effects. Drugs.com. Retrieved from http://ww w.drugs.com/sfx/xanax-side-effects.html Durand, V. M., & Barlow, D. H. (2010). Essentials of abnormal psychology. Australia: Wadsworth/Cengage Learning. Gunderson, J. G., & Links, P. S. (2008). Borderline personality disorder: A clinical guide. Washington, DC: American Psychiatric Pub. Hall, H. V. (1999). Lethal violence. New York: CRC Press. Ronningstam, E. F. (2005). Identifying and understanding the narcissistic personality. New York: Oxford University press. Sperry, L. (2003). Handbook of diagnosis and treatment of DSM-IV-TR personality disorders. Philadelphia, PA: Psychology Press. Read More