Task 5 Narcissism

Question 1

General description

Answer 1

Individuals act in a dramatic manner, seek admiration from others and are shallow in their emotional expressions and relationships with other. Furthermore they rely on their inflated self-evaluations

Question 2

Prevalence

Answer 2

in US 7.7% men and 4.8% of women, international (lecture) 1%
o Might rise in younger adults because of social and economic conditions that support more extreme versions of self-focused individualism

Question 3

Psychodynamical theories

Answer 3

symptoms of narcissistic PD are maladaptive strategies for managing emotions and self-views
o Rely on the praise and domination of others for their self-esteem

Question 4

Cognitive theories

Answer 4

Some people with narcissism develop unrealistically positive assumptions about their self-worth as the result of indulgence and overvaluation by significant others during childhood
o Other might develop it as defence against rejection or unmet basic needs by important people in their live

Question 5

Treatment

Answer 5

o Tend to not seek treatment except when they develop depression or have interpersonal problems
o Cognitive techniques: can help clients develop more realistic expectations of their abilities and more sensitivity to the need of others
o Schema therapy

Question 6

DMS-5 original model

Answer 6

• Describes a pervasive patterns of grandiosity, need for admiration and lack of empathy arising in early adulthood and present in variety of context, indicated by five or more of the following:
o A grandiose sense of self-importance
o Preoccupation with fantasies of unlimited success power brilliance beauty or ideal love
o Beliefs of being special and unique
o Requirements of excessive administration
o A sense of entitlement
o Interpersonal exploitativeness
o Lack of empathy
o Envy of others
o Arrogant, haughty behaviour or attitudes

Question 7

Limitations of original model

Answer 7

o Inconsistencies in the conceptualization of narcissism, including variants describing its nature (normal, pathological), phenotype (grandiosity, vulnerability), expression (overt, covert) and structure (category, dimension, prototype)
o Less impairing compared to other PDs, raising issues regarding its clinical significance
o Only modest research base
o Features of NPD were not statistically grounded, but appeared to be scattered across other symptom clusters
o Only focuses on the grandiosity narcissism

Question 8

Alternative model

Answer 8

o Categorical-dimensional hybrid model
 Combination of already existing criteria and dimensional system
o Criterion A: impairment in personality (self/interpersonal) need to fulfil two or more
 Self-functioning: involves identity and self-direction
 Interpersonal functioning: involves empathy and intimacy
 Measured in 5 levels of impairment (0 no 4 full)
o Criterion B: the presence of one or more pathological personality traits
 Five broad domains: Negative affectivity, detachment, antagonism, disinhibition and psychoticism
• Within these there are 25 specific trait facets
o Criterion C: The impairments in personality functioning and personality trait expression are relatively inflexible and pervasive across a broad range of personal and social situations
o Criterion D: relatively stable over time with onset that can be traced back to at least adolescence or early adulthood
o Criterion E: not better explained by another mental disorder
o Criterion F: not attributable to a substance or another medical condition
o Criterion G: not better understood as normal for an individual’s development stage or sociocultural environment

Question 9

Diagnostic criteria for NPD (alternative model)

Answer 9

 Typical features of Narcissistic Personality Disorder are variable and vulnerable self-esteem, with attempts at regulation through attention- and approval-seeking, and either overt or covert grandiosity. Characteristic difficulties are apparent in identity, self-direction, empathy, and/or intimacy, as described below, along with specific maladaptive traits in the domain of Antagonism
 A Moderate or greater impairment in personality functioning, manifest by characteristic difficulties in two or more of the following four areas
• Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem
• Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations
• Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others
• Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others’ experiences and predominance of a need for personal gain
 B Both of the following pathological personality traits
• Grandiosity (an aspect of Antagonism): Feelings of entitlement, either overt or covert; self-centeredness; firmly holding to the belief that one is better than others; condescending toward others
• Attention seeking: an aspect of Antagonism: Excessive attempts to attract and be the focus of the attention of others; admiration seeking

Question 10

Etiology

Answer 10

inheritance, temperament, psychological trauma and age inappropriate role assignments
o Prefrontal grey matter: Associated with emotional regulation, when small poor regulation
 Compromised empathic ability
o Insula: pain perception which is related to empathy

Question 11

Early signs in childhood

Answer 11

include primarily dismissing, i.e., contemptuous derogation and/or brittle idealization of attachment figures, anxious and avoidant, especially related to narcissistic vulnerability, or cannot classify with multiple, unintegrated attachment alternating between dismissing, devaluating, and angry or overwhelmed preoccupation

Question 12

Grandiose narcissists

Answer 12

copes with difficulties in self-esteem by viewing himself as superior and unique and by engaging in grandiose fantasies
o Tend to be: entitled, exploitative, envious and aggressive particularly when distressed

Question 13

Vulnerable narcissist

Answer 13

Copes with difficulties in self-esteem by engaging in grandiose fantasies to quell their intense shame
o Hypersensitive to rejection and criticism and thus avoid others

Question 14

Game playing love style

Answer 14

O Starting a relationship by charm, keep it as less intimate as possible, still look for other partners, if relationship ends transition to a new one is easier
O They get what they want while avoiding what they not want

Question 15

Self-regulation strategy

Answer 15

try to accomplish self-enhancement or maintenance of esteem by seeking and expressing superiority to or dominance over others

Question 16

Relationships

Answer 16

they seek status and self-esteem rather than intimacy or caring
O Rate themselves as superior
O Less commitment
 Might be caused by perception of elevated alternatives to the relationship

Question 17

Goals in interaction with others

Answer 17

esteem, status/power and sex

Question 18

Principle of least interest

Answer 18

maintaining alternative partners or keeping one’s partner uncertain about one’s commitment
 The individual less interested has the most power

Question 19

Need for power

Answer 19

Significant correlation with ludus and narcissism

Question 20

Need for autonomy in relationships

Answer 20

Significant correlation with ludus and narcissism

Question 21

Link between need for autonomy and power and NPD

Answer 21

It appears that the link between narcissism and ludus is mediated by both of these needs

Question 22

Role of commitment

Answer 22

O Strong negative relation between male narcissists and agape (not for women)
O Commitment: Ludus acts as mediator for commitment of a narcissist
O Mediational role of ludus on Alternatives and attention to alternatives:
 Ludus acts as mediator for alternatives and attention to alternatives in narcissists
 The link between narcissists ludic love styles and commitment was partially but not fully explained by alternatives

Question 23

Aggressive behaviour in NPD

Answer 23

• Combination of narcissism and social rejection is a powerful predictor of aggressive behaviour
• Narcissism is generally linked to more aggressive behaviour
• Violence was often a response to ego threats by persons with inflated self-views

Question 24

Failure feedback

Answer 24

o After receiving failure feedback narcissistic persons were more likely to show direct aggression and displaced aggression

Question 25

Study 1

Answer 25

o Anger is positively correlated with narcissism and internalized negative effects negatively after social rejection

Question 26

Study 2

Answer 26

o Aims to tackle the possibility that narcissists simply don’t want to talk about situations that made them experience internalized negative emotions
 Laboratory settings
o Results: Narcissists demonstrate more anger after social rejection
 Did not show aggression after being accepted, even showed less internalized emotions after accepted

Question 27

Study 3

Answer 27

same as 2 but they could punish people with a loud noise (variable duration and intensity)
o Results: Narcissism leads to higher aggression even with and without self-esteem controlled
 They are also more behavioural aggressive toward people who have rejected them

Question 28

Study 4

Answer 28

displaced aggression (aggression against an innocent third party)
Narcissists were more aggressive even against an innocent third party
 Even when self-esteem and gender were statistically controlled
o Limitation: innocent party was a student from the same university
 Might be caused by group rejection

Question 29

Emotional detachment

Answer 29

both from their own feeling and the feelings that they can perceive and/or evoke in others

Question 30

Problems in emotional processing regulation

Answer 30

o Feel a feeling
o Tolerate the nature and/or intensity of a feeling
o Identify and verbalize a feeling
o Identify the physiological/visceral indications of an affect and translate them into emotional experiences
o Integrating ones own feeling and intention into an interpersonal context

Question 31

Alexithymia

Answer 31

is the inability to identify and describe feelings in words and to differentiate feelings from bodily sensations caused by emotional arousal
o Also relates to others orientation

Question 32

Cluster A

Answer 32

Odd-eccentric personality disorders  They have symptoms similar to those of people with schizophrenia, including inappropriate or flat affect, odd thought and speech patterns, and paranoia. However, people with these disorders maintain their grasp on reality.
- Schizotypal, Schizoid and Paranoid personality disorder.

Question 33

Cluster B

Answer 33

Dramatic-emotional personality disorders  They 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 safety or needs of others.
- Antisocial, Borderline, Histrionic and Narcissistic personality disorder.

Question 34

Cluster C

Answer 34

Anxious-fearful personality disorders  They are extremely concerned about being criticized or abandoned by others and thus have dysfunctional relationships with others.
- Avoidant, Obsessive-Compulsive and Dependent personality disorder.

Question 35

Alternative model of personality disorder in DSM-5 section III

Answer 35

This alternative model incorporates a dimensional/continuum perspective. It is not meant for current clinical use and it is seen as an approach to responding to problems that categorical diagnostic system poses. This model characterized PD’s in terms of impairments in personality functioning and pathological personality traits. Three steps in diagnosing PD:
1. Determine level of functioning in terms of sense of self or relationships (No impairment  Extreme impairment – Must at least have moderate level).
2. Determine any pathological traits, which have significant overlap with Big 5 – Negative affectivity, detachment, antagonism, disinhibition & psychoticism.
3. Determine whether individual meets criteria for any of six specific disorders (= antisocial, avoidant, borderline, narcissistic, OC and schizotypal) – If no criteria were met, diagnosis of personality disorder-trait specified is given.
 Main limitations of categorical perspective – (1) 10 separate PD have some overlap in diagnostic criteria; (2) Longitudinal studies have found that people with disorders varied over time in how many symptoms they showed and their severity (more pronounced when accompanied with depressive disorder); (3) Despite having 10 disorders, DSM criteria did not fit many people, nor did they reflect fundamental personality traits consistent across cultures.