Case Study of Narcissism

Narcissist Personality Disorder

Examining narcissistic personality disorder (NPD)

What is Narcissistic Personality Disorder?

Narcissistic Personality Disorder (NPD) is commonly termed as 'a continuous pattern of magnificence (fantasies and illusions), desire for praises and lacking compassion'. It is notably described by five key elements as mentioned below:

Illusions of self-importance

An obsession with illusions of huge success, fame, love, beauty and wealth

Faith in being unique / special

Desiring constant praise

Having a sense of entitlement

Being manipulative

Lacking compassion

Jealous of others

Increasingly arrogant / ego-maniac / having attitude problem (Skodol, Bender & Morey, 2014).

Features and symptoms of NPD

NPD (Narcissistic Personality Disorder) are typically indicative of susceptible self-esteem where attention seeking and desiring constant praises are a given, whilst having overt and covert illusions of grandeur. There are troubles in having an identity, intimacy, compassion, self-direction and lastly, certain maladaptive characteristics of antagonism (Skodol, Bender & Morey, 2014). These characteristics explain NPD's diagnosis:

A. With mediocre or increased impairment in a person's behavior is the cause of trouble in two or more than two areas:

1. Identity: Many references to other individuals for maintaining self-esteem and self-definition. Self-appraisal can be extravagant or deflated, or can alternate between both. The emotional behavior alternates due to self-esteem.

2. Self-direction: Setting of goals is based on other's validation; individual standards are sky high with a desire to view oneself as superior or too inferior depending on sense of entitlement; largely unaware of one's motivations.

3. Empathy: Lacking the capacity to feel, recognize and identify other's needs. The individual is wary of other's reactions, having tendency to get vulnerable about himself; can exaggerate or underrate his influence on others.

4. Intimacy: Interpersonal relationships are insincere and remain active for boosting self-morale; least interest in other's life and experiences; desiring individual gain.

B. These are pathological personality traits:

1. Grandiosity (an aspect of Antagonism): The individual is covertly or overtly self-centered, entitlement feelings are commonplace; having a better than average belief; condescending others.

2. Attention seeking (an aspect of Antagonism): The natural instinct of seeking attention and admiration of others around.

The fundamental traits of NPD are alternating and sensitive self-esteem, with constant attempts of maintaining approval and seeking attention whilst harboring covert / overt illusions of grandeur. The extent of impairment in a person in case of NPD should be in reasonable range. Either two of these four areas of interpersonal impairment and characteristic self are needed. People having NPD disorder are mostly self-centered having aims which exist to please others around them (Skodol, Bender & Morey, 2014).

Behavioral Manifestation of Narcissistic Personality Disorder

Narcissism has been the center of research by personality and social psychologists during the last decades. Still, more research is needed to observe narcissists in daily lives. There was a recent study conducted by Mehl, Vazire, Holtzman (2010) to observe, how narcissists behaved in real life. With the help of Electronically Activated Recorder (EAR), the behavior of candidates was observed and assessed. As per the results, the fundamental traits of narcissism which were collected via lab-based studies and questionnaire naturally existed in narcissist's daily life.

Narcissism was related to extraverted behavior (interacting with friends), usage of foul language (swearing and cursing) and making sexual allusions (nude). Apart from that, entitlement / exploitativeness is another maladaptive aspect of narcissism. It's related to disconnection from academics (being absent from classes). On the whole, the research concluded that narcissism has affirmative and harmful effects. In most cases, women show this characteristic more than men since their extraverted behavior enable them to have a good impression at first (making friends and socializing); in the long run, they tend to experience trouble maintaining their reputations.

Apart from that, narcissists are predominantly unaware of these traits, yet all indicators are pointing in one direction. As per another research, entitled / exploitative narcissists are absent in classes. As per this research, it's a mechanism due to which the individual disconnects from academics with the passage of time, due to feelings of increased self-importance which results in dismal academic performance. In addition to that, narcissist's imprudent academic behavior (cutting classes due to entitlement / exploitativeness) corresponded to an impulsive sexual behavior (constant talk about sex).

Narcissists as per research-based evidence are impulsive and are inclined towards short-term gains. The relation between sexual language and narcissism gives viable clues about the connection of narcissism and promiscuous sexual intentions. As per empirical evidence, ex-partner reports as well as self-reports of infidelity are related to narcissism. The element is apparent in the research since narcissists' usages of sexual language in daily lives are a predominant factor, which is an indicator itself (Holtzman, Vazire & Mehl, 2010).

Building on the foundation of narcissism as a defense mechanism for preventing feelings of vulnerability; it's been generally observed that narcissistic people have trouble maintaining their self-esteem. Such people suffer from constant and frequent fluctuations of self-esteem. They have the tendency to misrepresent themselves and others along the way. Due to this reason, they frequently have delusions of grandeur, pits of depression, self-incrimination and lack of tolerance for uncertainty with varying degrees (Levy, 2012).

Furthermore, the narcissistic people have a tendency to give importance to comparatively smaller things / events and achievements. They are quite susceptible to criticism from others, sensitive to feedback and get heavily depressed in the event of a failure. When they get depressed, they contact other individuals whom they look up to and seek inspiration from. In extreme cases of failure, they might even commit suicide. In order to balance themselves, these narcissistic individuals keep altering others' sense of importance in order to retain their self-esteem. Self-esteem is a very sensitive subject for narcissistic individuals as they experience shifts in this domain a lot (Levy, 2012).

Narcissism has certain aspects which are covert and some others are overt. These demonstrate different clinical manifestations of this disorder. Narcissistic individuals have certain beliefs about themselves which alternate between covert and overt symptoms of clinical expression. Hence, in case of overtly narcissistic, individuals are known to show entitlement, exhibitionism and magnificence. In an event of failure / loss, these individuals can become extremely depressed, dejected and feel mediocre. In case of covertly narcissistic individual, he is quite shy, reserved and timid up close; upon closer inspection, he's a victim of grand illusions and an exhibitionistic at best (Levy, 2012).

Narcissism has many appearances which can be categorized on a severity scale from normal to pathological. It can be segmented into high, middle and low functioning pathological narcissists. In extreme cases, patients fulfill their self-esteem needs by attaining admiration from individuals around.

The patients behave normally during their lifespan but can breakdown mentally as their age progresses since their fantasies don't translate into reality. On the lowest level, the patients suffer from comorbid borderline personality traits. The patients are mentally unstable and diffused as they alternate between verge of suicide and grandiosity. In case of extremely lowest narcissistic levels, individuals suffer from malignant narcissism. Such patients show the conventional symptoms of NPD. Apart from that, they are antisocial, sometimes paranoid and are pleased in being aggressive and cruel to other people (Levy, 2012).

Consequential symptoms of Narcissism

Aggression

Aggression is another byproduct of narcissism as per social behavior research. According to multiple researches on narcissism, aggression has been observed in a wide variety of responses when the said individual is criticized or when his self-esteem is threatened. The corresponding behavior can lead to disdain, contempt, anger, argumentative behavior and violent behavior. Most of the research had made use of laboratory aggression paradigms, where the candidates are given fake feedback from another candidate, then the candidate behaves aggressively (shouts or uses physical force) towards the other individual. As per most studies, narcissism is connected to aggressive behavior in both triggered and non-triggered situations. For example, narcissism is the basis of a shouting session to a person who threatens the self-esteem of the individual (Miller, Widiger & Campbell, 2010).

Self-enhancement and cognitive distortion

As per conceptualizations of narcissism in clinical and social-personality domains, the element of self-esteem maintenance / self-enhancement exists. It can be termed as self-biased, habitually taking credit for success for certain work, yet blaming external factors and people for failure. During lab studies, narcissism gives rise to self-bias. Narcissism is also the reason for self-bias in interpersonal relationships. Apart from that, narcissistic individuals will take credit of others important to them. Narcissism is the basis of better than average effect in which an individual feels that he's better than another person due to some characteristic (looks, appearance, and intelligence). Apart from that, narcissism bases its better than average effect on characteristics of decisiveness and intellect (Miller, Widiger & Campbell, 2010).

Social-personality literature presents empirical evidence that narcissism is associated with many cognitive distortions. Narcissist individuals are generally overconfident. They exaggerate their knowledge and neglect critical feedback provided to them. Due to this self-confidence, false beliefs are formed which are called over claiming. It means claiming to know something which is entirely wrong (Miller, Widiger & Campbell, 2010).

Impaired relationships

The consequences of narcissism are quite notable in interpersonal settings. Generally speaking, trait narcissism indicates behaving in such a manner that one becomes likable and friendly to strangers in the first encounter. But this friendliness fades away with passage of time as the nature of the narcissistic person comes into light. Apart from that, many researches have shown that strangers seem to like the narcissistic individuals during first encounters with them. The empirical evidence on narcissistic individuals has taken interpersonal relationships in consideration which entails dating and marriage. With the passage of time, narcissism impacts negatively on the relationships since it's connected to unfaithfulness, game playing and limitless sociosexuality. In their initial meetings, these narcissistic individuals seemly are very charming, eye-catching and adventurous. But this early on charm leads to conflicts and issues in future (Miller, Widiger & Campbell, 2010).

Externalizing behaviors

Keeping in mind the clinical issues, trait narcissism is associated to a hoard of maladaptive externalizing behaviors such as, high consumption of alcohol, gambling, habitual spending and anti-social behavior. Such behaviors are directly related to appetite related problems, reward seeking nature and the tendency to neglect others needs. The association between NPD / narcissism and other externalizing behaviors is a direct byproduct of these constructs and psychopathy (Miller, Widiger & Campbell, 2010).

Causes of Narcissistic Personality Disorder (NPD)

The second one is that some temperaments can be risky for children in case of environmental stressor. Hence, this amalgamation between genes (temperament) and environment (parenting) can stimulate NPD (Wright & Furnham, 2014).Theories tend to give preference more to environmental factors rather than biological factors for causing NPD. Genetics can play a pivotal role in instigating NPD since narcissism can also be hereditary, even though the amount of research on how genetics stimulates NPD is razor thin. It can be seen in infants having different degrees of temperament (reactiveness and self-regulation) which could be purely biological. There are two theories as to how differences in temperament can stimulate personality disorders. The first is the child's temperament becomes problematic for caregivers which can worsen the child's problems.

Due to inherited alterations in strong aggressive behavior, hypersensitivity, tolerance, frustration, low anxiety and lastly affect regulation defects are notable causes for developing NPD. Apart from that, it's been proposed that keeping in mind the infant's mental state, caregiver's prejudices and lack of adequate mirroring stimulates NPD development. As per the theoretical accounts, the evolving grounds of narcissistic character-logical self-regulation are deeply identified. These traits help protect the self-esteem of an individual in life, although he is largely unaware of these traits naturally. He deems it a natural part of himself (armor cladding insecurity, guilty feeling, depression, anger and anxiety).

Despite, their involvement in making a person uptight, distancing from others and provocative behavior, the person in absence of these is quick to portray episodes of anger, regret, shame and defensive reactions for instance devaluation, blaming and self-esteem boosting patterns. As per one research, NPD afflicted individuals can be troublesome to others close to them prior to owning their shortcomings and deficiencies after which episodes of depression and anxiety takes over. Children should learn to dwell in both words: External world in which others opinions and expectations matter while in an internal one where they have their own experiences, reactions and feelings. Some became increasingly shelled; some overcame their deficient and shortcomings while others exceeded expectations with respects to a child's routine developmental process (Ronningstam, 2010).

As per a recent research, cold parenting and overestimation (irrelevant praise and admiration of the child's talents and abilities) were the deciding factors for covert and overt narcissism. In a different research, avoidance attachment and anxiety attachment resulted in covert narcissism. The former demonstrated wary of rejection while the latter demonstrating protecting the delicate self. Both of these non-clinical research samples and clinical accounts denote a complication in interpersonal, experiential and developmental patterns which paves way for narcissistic pathology (Ronningstam, 2010).

NPD can be caused due to different reasons depending on varying degrees of narcissism since vulnerable narcissism is acutely associated with anxious attachment model while delusional narcissism is acutely associated with dismissive attachment style. Vulnerable narcissism is interrelated to child abuse as per research while grandiose narcissism isn't (Wright & Furnham, 2014).

As per a diagnostic term proposed lately, trauma related narcissistic symptoms shows that stress associated to outward traumatic experience in individuals, can devastate a person and instigate narcissistic indicators for instance rage, humiliation and shame. Trauma related narcissistic indicators are stimulated by certain noteworthy events which penetrates the narcissistic shield of the individual (internal control, person's self-respect and self-regulatory functions). These events have varying degrees of intensity and duration, yet for the individuals, it's a humiliating blow for them (Ronningstam, 2010).

Treatments for Narcissistic Personality Disorder

Psychodynamic and psychoanalytic domains have proposed treatments for NPD. Long-term psychodynamic treatments are best advised for treating NPD. The psychoanalysts have proposed two forms of psychodynamic cures for treating NPD. Heinz Kohut and Otto Kernberg are the two psychoanalysts. In this form of treatment, the patient admires the therapist since his/her parents weren't admired. The patients can observe how the parent-child relationship factors in their NPD development (Wright & Furnham, 2014).

The aim of Kernberg is to uncover the defense mechanism namely delusional grandeur in this case which is signified in this transference, hence connecting narcissism with healthier aspects of one's personality. Mobilization helps in reenacting relationships parents have with their children (idealization and total control). The analyst methodically construes the affirmative and undesirable elements of transference.

The undesirable elements are based on recognition of patient's struggles against control and idealization functions as a twin function. They tend to be defensive to envy, verbal anger and feelings of guilt appear after the anger episode. Moreover, they desire to have a healthy affiliation with the analyst: patients are liable to prevent hateful sentiments which could threaten a healthy relationship which they desire so desperately in quest for undying love.

Kernberg remains firm on the fact that neglecting negative traits entirely escalates the patient's fear of unknown aggression, hence his level of narcissistic resistance increases and leads to a dangerous level of development of delusions of self-grandeur.

Positive transference's interference centers on residue which exists basically for object love and plausible appreciation for the work done by analyst. Hence the patient is assisted in facing and verbalizing the separation jealousy, bitterness as he becomes aware of the fact that the said analyst is the actual person he longed for. Hence, the patient comes to a self-realization about acknowledging his analyst and other beings as independent beings: those they need and those they love (Russel, 1985).

In comparison, Kohut thinks that, transference is reactivated during the infantile narcissistic images (the delusions of grandeur and idealized object) which aren't fully developed yet. The treatment is aimed at allowing its expansion, hence forming a consistent self-image and fostering an archaic narcissism in a matured phase. The archaic delusions are revitalized as 'mirror transference' matures, as the analyst helps in identification. The patients in attendance are expecting a validation of their self-delusions which they couldn't attain at early age. The analyst helps in regurgitating the patient's self-delusions of grandeur and self-glorification, exclusively the desire to be acknowledged by the analyst himself.