NPD

Question 1

DSM

Answer 1

Grandiosity, need for admiration and lack of empathy. 5 om

1. Grandiose sense of self
2. Preoccupied w fantasies of succes
3. Believe they’re special/unique
4. Requires admiration
5. Sense of entitlement
6. Interpersonally exploitative
7. Lacks empathy
8. Envious of others/belief they are
9. Shows arrogant behaviour

Question 2

3 types of narcissism

Answer 2

1. Grandiose (DSM)
2. Fragile/hypervigilant/vulnerable. Grounded by low self-esteem/loneliness
3. High-functioning/exhibitionist. outgoing and energetic, often charming.

Question 3

Comorbidity

Answer 3

MDD(20%)
BDI (20%)
anxiety (54%)
SUD (65%)

Often reason to seek treatment (not for NPD). NPD may worsen prognosis

PDs:
HPD and ASPD(=worst prognosis) most common
BPD frequently present (37%)

Question 4

Kernberg’s model

Answer 4

Defense model: Grandiose self is defense against dependency on others. Aggression is inborn, resulting in significant envy.
Idealization is a defense against aggression. Mostly reflect grandiose/oblivious narcissist.

Question 5

Kohut’s model

Answer 5

Deficit model: Grandiose self is result of deficit originating from empathic failures of caregivers.
Nondefensive, normal and appropriate mirroring.
Aggression is secondary, idealization is normal given arrested development.
typically reflects the vulnerable narcissist

Question 6

Parental styles

Answer 6

Overvaluation predicted narcissism, parental warmth and accurate assessment of the child resulted in nonpathological view of self.

Question 7

(Counter)transference

Answer 7

Transference:
- ignorant, self-centred (Grandiose/oblivious)
- Self loathing, sham (vulnerable)
- Idealization/devaluation
- Resistance

Countertrans
- Bored/tired/uninterested (grandiose)
- mirroring needs, emotionally draining
- feeling idealized/devalued

Question 8

Treatment

Answer 8

Mostly treatment used for BPD;
TFP
MBT (improving self-reflection)
DBT
ST (cognitive reframing)
Group therapy (diff to them but can be useful to help diffuse transference)

Question 9

General principles

Answer 9

Setting treatment frame
- Responsibilities for both, as NPD is likely to deviate (entitlement)

Therapeutic alliance
- Challenging but important to set realistic goals and overcome (counter)transference

Consider discussing diagnosis
- Can effect alliance. Can choose to remain with treatment goals

Don’t ignore grandiosity
- don’t directly challenge, but explore the function it serves.