Task 5 - Narcissism Flashcards
Personality Disorder
The general criteria for a personality disorder specify that an individual’s personality patterns must deviate significantly from the expectations of his or her culture as shown in the styles of thinking about oneself, others, or events; emotional experience and expression, interpersonal functioning; and/or impulse control
Cluster A: Odd-Eccentric Personality Disorders
People with these disorders have symptoms similar to those of people with schizophrenia, including inappropriate or flat affect, odd thought and speech patterns, and paranoia.
Paranoid Personality Disorder: A pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent
Schizoid Personality Disorder: A pattern of detachment from social relationships and a restricted range of emotional expression
Schizotypal Personality Disorder: A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior
Cluster B: Dramatic-Emotional Personality Disorder
People with these disorders tend to be manipulative volatile, and uncaring in social relationships. They are prone to impulsive, sometimes violent behaviors that show little regard for their own safety or the safety or needs of others.
Antisocial Personality Disorder: A pattern of disregard for, and violation of, the rights of others; criminal, impulsive, deceitful, or callous behavior; lack of remorse
Borderline Personality Disorder: A pattern of instability in self-image, mood, and interpersonal relationships and marked impulsivity; transient dissociative states; highly reactive to real or imagined abandonment
Histrionic Personality Disorder: A pattern of excessive emotionality and attention seeking; dramatic, seductive, or provocative behavior; suggestible; shallow emotional expression and relationships
Narcissistic Personality Disorder: A pattern of grandiosity, need for admiration, and lack of empathy; entitled, arrogant, and exploitative attitudes and behavior
Cluster C: Anxious-Fearful Personality Disorders
People with these disorders are extremely concerned about being criticized or abandoned by others and thus have dysfunctional relations with others.
Avoidant Personality Disorder: A pattern of social inhibition, feelings of inadequacy, and a fear of being criticized, which lead to the avoidance of social interactions and nervousness
Dependent Personality Disorder: A pattern of submissive and clinging behavior related to an excessive need to be taken care of, and leading to high levels of dependence on others
Obsessive-Compulsive Personality Disorder: A pattern of preoccupation with orderliness, extreme perfectionism, and control, leading to emotional constriction, rigidity in one’s activities and relationships, and anxiety about even minor disruptions in one’s routines
Alternative DSM-5 Model for Personality Disorders
- it incorporates a dimensional/continuum perspective
- 10 previously determined PDs have too much overlap
- there are atypical PDs
- Determining an individual’s level of functioning
- Determining whether the individual has any pathological personality traits
- negative affectivity
- detachment
- antagonism
- disinhibition
- psychoticism - Determining whether individuals meet the criteria for these six specific disorders –> otherwise, personality disorder- trait specified
Narcissistic Personality Disorder
= individuals act in a dramatic manner, seek admiration from others, and are shallow in their emotional expressions and relations with others
Characteristics of NPD
- inflated self-evaluations
- dependency on others is perceived as weak and threatening
- grandiosity, self-importance, and superiority
- fantasies of power and success
- ignore and devalue the needs and wants of others
- exploit others to gain power
- condescending
- detached from their own feelings and feelings they can perceive/evoke in others
Prevalence
- 1% of the general population
- 7.7% of men
- 4.8% of women
- more prevalent among younger adults
Comorbidity
- substance abuse
- mood disorder
- anxiety disorder
- physical and sexual aggression
- impulsivity
- homicidal thoughts
Subtypes of Narcissism
Grandiose narcissism: A grandiose narcissist copes with difficulties in self-esteem by viewing himself as superior and unique and by engaging in grandiose fantasies
- arrogant, manipulative, exploitative, aggressive
Vulnerable narcissism: A vulnerable narcissist copes with difficulties in self-esteem by engaging in grandiose fantasies to quell intense shame
- hypersensitive to rejection and criticism
Causes: Psychodynamic Approach
- the symptoms of NPD are maladaptive strategies for managing emotions and self-views
- associated with a history of childhood adversity
- overly permissive/controlling parenting
Causes: Cognitive Approach
- unrealistic positive assumptions about their self-worth
- overvaluation by significant others during childhood
- belief that they are unique or exceptional as a defense against rejection or unmet basic emotional needs by important people in their lives
Causes: Multifactorial etiology of NPD
- Inheritance
- Temperament
- Psychological Trauma
- Age-inappropriate role assignments
Causes: Attachment styles
dismissing attachment: contemptuous derogation and/or brittle idealization of attachment figures
anxious and avoidant: related to narcissistic vulnerability
cannot classify attachment: multiple unintegrated attachments alternating between dismissing, devaluating, and angry or overwhelmed preoccupation
Causes: Brain Functioning
Prefrontal gray matter (GM) volume deficits:
- affect emotion regulation and emotional and empathic processing
Causes: Alexithymia
= ability to identify and describe feelings in words and to differentiate feelings from bodily sensations caused by emotional arousal
- narcissism is associated with comprised ability to describe one’s own feelings to other people
Emotion Recognition and Processing Problems
Emotion Recognition:
- less accurate in recognizing emotional expressions in others
Emotion Processing:
- difficulties processing shame, fear, anger
–> high suicide risk
Empathy in Narcissists
- empathy ability in NPD is comprised and fluctuating
–> no deficits in cognitive empathic capability
–> significant impairment in emotional empathy
Love Styles
eros: physical passion and a desire for rapidly escalating romantic involvement
ludus: game playing, an aversion to partner dependence, attention to extradyadic others, and deception
storge: emphasis on companionship and trust in relationships
pragma: a pragmatic or practical approach to romantic relationships
mania: painful obsession with the love object and alternating experiences of joy and sorrow in the relationship
agape: a selfless regard for the well-being of the romantic partner
Narcissists’ Approach to Love
- Narcissists see themselves as smarter, more attractive, and more socially extraverted than others
- They are less likely to desire intimate or caring relationships with others: their goals include esteem, status/power, and sex
- Narcissists have several skills and strategies that are effective in their nonromantic and romantic relationships: self confidence, extraversion, charm, manipulation
–> narcissism is positively related to ludus/game-playing approach to love
–> need for power and autonomy
–> less commitment
–> seek alternatives
Narcissism, Social Rejection, and Aggression
- violence is a response to ego threats
- anger in response to failure feedback
- anger after being rejected
- feel fewer internalized negative emotions in response to both acceptance and rejection
- direct aggression: aggression against the perpetrators of social rejection
- displaced aggression: aggression against individuals who might be viewed as members of the rejection group, even if it is broad
Treatment
- people with NPD tend not to seek treatment
- collaborative therapeutic approach: develop more realistic expectations and more sensitivity to the needs of others
Do’s in Treatment
- Help the patient identify concrete, realistic, and measurable treatment goals that the patient identifies as his or her own
- Help develop a sense of agency; identify a patient’s strengths and weaknesses and help connect those to treatment goals
- Help the patient shift from grandiosity and self-loathing to discussing experiences and real competence and weaknesses; encourage curiosity and tolerance of uncertainty
- Use an exploratory problem-solving approach to develop a “Collaborative Therapeutic Alliance”
- contractual agreement
- defining roles and responsibility
- attachment building - Use contracts to anticipate threats to the alliance and productive collaboration, with ultimatums as a last resort
- Address treatment-interfering behaviors as they come up in treatment
Don’ts in Treatment
- Do not ignore countertransference
- Do not engage in a power struggle or misuse of power
- Do not directly challenge the patient’s grandiosity or self-loathing
- Do not overindulge the patient’s sense of grandiosity or self-loathing
- Do not use overly empathic interventions
- Do not ignore self-esteem-relevant life events
