The Clinician's Guide to the Diagnosis and Treatment of Personality Disorders by Fox Daniel

Author:Fox, Daniel [Fox, Daniel]
Language: eng
Format: epub
Publisher: PESI Publishing
Published: 2019-04-24T16:00:00+00:00

List three things that led up to your behaving in way that was later found to be detrimental.

Draw a picture of how you see yourself and how you think the world sees you:

List three goals for treatment you want met within the next 2-4 weeks:

List three long-term goals you would like to achieve through treatment:

Narcissistic Personality Disorder

Narcissistic personality disorder (NPD) describes an individual with an underlying fragile ego who displays an overconfident, often cocky, and aristocratic style. The term narcissism is rooted in the Greek mythological figure of Narcissus, who rejected the advances of the nymph Echo and, as punishment, fell in love with his own reflection in a pool of water. As Narcissus pined away, gazing at his own reflection, he changed into a flower that bears his name, the narcissus (Graves, 1993). The story has been retold countless times. The first psychoanalytic paper to address vanity and narcissism was published by Otto Rank in 1911 (Millon et al., 2004). In 1914, Freud (1914/1957) published On Narcissism: An Introduction, that addressed the repression of any information or emotion that lessens the individual’s sense of self, as well as the dimensional aspect of narcissism from a balanced self-concept to one of grandiosity as a defense mechanism. Freud never viewed narcissism as a personality disorder but rather as a personality type (Levy, Reynoso, Wasserman, & Clarkin, 2007).

Kernberg (1967) used the term “narcissistic personality structure,” and later (Kernberg, 1970) furthered his description to include clinical characteristics and foundational components including overt behavior that can distinguish between normal and pathological narcissism. Kohut (1968) was the first to use the term “narcissistic personality disorder,” which he used to describe long-term characterological functioning. Both Kernberg (1967) and Kohut (1968) were interested in narcissism and its treatment. They disagreed regarding the etiology of NPD but agreed on its expression, especially for individuals who possessed a healthier form of the disorder.

Narcissistic personality disorder was not included in the first two editions of the Diagnostic and Statistical Manual (DSM), but made its first appearance in the DSM-III (APA, 1980). The criterion set included the following: grandiose sense of self-importance or uniqueness; preoccupation with fantasies of success, power, brilliance, beauty, or ideal love; exhibitionism; indifference, rage, shame, humiliation, or emptiness in response to criticism or defeat; feelings of entitlement; interpersonal exploitativeness; over-idealization and devaluation of others; and lack of empathy. The definition in the DSM-III was derived from writings prior to 1978 that were considered by a committee of psychiatrists and psychologists who reached a consensus on various aspects of the disorder. No empirical studies were included (Levy et al., 2007). The DSM-III-R (APA, 1987) added feelings of envy and the belief that one’s problems are unique, and deleted the criterion of the alternation between feelings of idealization and devaluation was deleted due to overlap with borderline personality disorder (BPD; Widiger et al., 1988).

Ronningstam and Gunderson (1990) attempted to provide an empirical basis to improve the criterion set for NPD and were able to successfully distinguish individuals with NPD from those with other personality disorders and/or individuals with other psychiatric disorders.

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