Personality Disorders by Mario Maj

Author:Mario Maj
Language: eng
Format: mobi, pdf

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Narcissistic Personality Disorder: A Review

Elsa Ronningstam

McLean Hospital, Harvard Medical School, Belmont, Massachusetts, USA

INTRODUCTION Our knowledge on narcissism and narcissistic personality disorder (NPD), accumulated during the past century, stems mostly from three major areas of inquiry: individual case studies of treatment of narcissistic people in psychoanalysis structured and narcissistic characteristics and NPD in patients in psychiatric settings; and studies in the field of academic social psychology using laboratory experiments and inventories for exploring specific narcissistic traits and behaviours. This paper reviews both clinical and psychoanalytic, and empirical psychiatric and psychological evidence based studies of pathological narcissism and NPD. It includes an outline of a diagnostic formulation and criteria for NPD that integrate present observations on self-esteem dysregulation, affect dysregulation and specific behaviours and dysregulations in interpersonal relationships. Three types of NPD are discussed as well as some of the most important differences vis-a`-vis near neighbour Axis I and Axis II disorders.

and dynamic psychotherapy; empirical studies using semi-structured diagnostic instruments for evaluating

THE SCOPE OF NPD

Definitions of Pathological Narcissism and NPD The terms ‘‘pathological narcissism’’, ‘‘narcissistic disorder’’ and ‘‘narcissistic personality disorder’’ have been used interchangeably in the clinical literature. For the purposes of clarification, the following definitions of pathological narcissism, narcissistic traits/features/characteristics, and NPD will be used throughout this paper.

Personality Disorders. Edited by Mario Maj, Hagop S. Akiskal, Juan E. Mezzich and Ahmed Okasha. Ù2005 John Wiley & Sons Ltd: ISBN 0-470-09036-7 Narcissism refers to a dimension ranging from healthy, to pathological, to the enduring NPD, and identified by degree of severity, dominance of aggression versus shame, and by the extent to which its manifestations are overt or internally hidden. Pathological narcissism differs from healthy or normal narcissism since the self-esteem regulation is dysfunctional, serving to protect and support a grandiose but fragile self. Affect regulation is compromised by difficulties to process and modulate feelings, specifically anger, shame and envy. Interpersonal relationships are also affected as they are used primarily to protect or enhance the self-esteem and other selfregulatory functions at the expense of mutual relativeness and intimacy.

Pathological narcissism can be more or less obtrusive on an individual’s sustained personality functioning. When the level of pathological narcissism is less severe, temporary, situational or limited to a set of specific character features that interfere to a lesser degree with regular personal, interpersonal and/or vocational functioning, it is referred to as narcissistic disturbance or narcissistic traits. The diagnostic term NPD refers to a stable long-term characterological functioning that meets the DSM-IV criteria for NPD or any other comprehensive diagnostic description [1–8]. NPD refers to specific deformations in the personality structure that involve a pathological grandiose self, impaired affect regulation, unintegrated object relations, and inconsistent and/or overly harsh superego functioning. The self-esteem is inconsistent and fragile and maintained by pathologically defensive, expressive and supportive regulatory processes. Affect regulation is influenced by feelings of rage, shame and envy, and the capacity for empathy and interpersonal commitment is impaired.

In addition, in a recently proposed diagnostic term, ‘‘trauma-associated narcissistic symptoms’’ (TANS) [9], the stress associated with an external traumatic experience overwhelms the self and triggers symptoms such as shame, humiliation and rage.

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