Several of my posts have already looked in some detail at the link between childhood trauma and the subsequent risk of developing a personality disorder (or disorders) if appropriate psychotherapeutic intervention is not sought.
Whilst precise mechanisms underlying the link between childhood trauma and subsequent development of a personality disorder are still being researched, it is a statistical fact that the experience of childhood trauma and personality disorder are very frequently indeed seen to be ‘comorbid’ (this is a psychological term used to mean existing in the same patient – ie if the patient has a personality disorder, he/she very probably also experienced severe childhood trauma).
Suffering from a personality disorder has a profoundly damaging impact on a person’s life if it is left untreated. People who suffer from personality disorders tend to have very rigid, inflexible and damaging (both to themselves and others) ways of managing vital areas of their lives such as work, relationships and even leisure time which, naturally, causes a whole host problems.
In this post, I want to look specifically at narcissistic personality disorder.
NARCISSISTIC PERSONALITY DISORDER :
A good place to start is to look at how the DSM-IV (a diagnostic manual used by psychologists and psychiatrists) defines narcissistic personality disorder. Here’s the definition :
‘a pervasive pattern of grandiosity, need for admiration, and lack of empathy’
Other features of narcissistic personality disorder are :
– a grandiose sense of self-importance
– expectations of being treated as special
– extremely fragile sense of underlying self-esteem
The psychologist Masterson (1981) expanded upon the definition to include two particular types of narcissist:
1) the manifest narcissist
2) the ‘closet’ narcissist
Let’s look at both of these :
1) the manifest narcissist : similar to the description provided in DSM-IV (above)
2) the ‘closet’ narcissist : the person suffering from this disorder tends to present him/herself as timid, shy, inhibited and ineffective but reveals in therapy elaborate fantasies of a grandiose self
Narcissistic personality disorder is thought to be due to ARRESTED DEVELOPMENT. In therapy s/he will tend to seek the admiration s/he craves from the therapist, and, if the therapist is skilled and experienced, s/he will often uncover an array of psychological defense mechanisms which the patient uses to protect him/herself from unbearable emotional pain. These can include :
1) IDEALIZATION : this is often the primary defense whereby the individual IDEALIZES HIS/HER RELATIONSHIPS at first, elevating both self and other in terms of status and specialness to (illusionary) high levels
2) DEVALUATION : this refers to the individual discounting and regarding as worthless anyone who undermines his/her grandiose vision of him/herself
3) DETACHMENT : this is linked to DEVALUATION (above) and refers to the individual’s propensity to sever links with anyone who threatens to undermine his/her exalted view of him/herself
4) ACTING OUT : this refers to performing extreme behaviours to express thoughts, feelings and emotions the person feels incapable of otherwise expressing
5) SPLITTING : this refers to the cutting off from consciousness the part of themselves that holds the emotional pain to prevent it from becoming integrated into consciousness, as, for this to occur, would be psychologically overwhelming
6) PROJECTIVE IDENTIFICATION : this is when the person (unconsciously) projects onto another (imagines the other to possess) parts of their own ego and then expects the other to become identified with whatever has been projected
7) DENIAL : in its simple form this just means not accepting certain unpleasant parts of reality to protect the ego
8) AVOIDANCE : also sometimes referred to as ‘escape coping’ – making efforts to evade dealing with particular stressors
9) PROJECTION : this defense mechanism involves attributing to others one’s own unwanted or socially/culturally unacceptable emotions, attributes or thoughts
In essence, the individual with narcissistic personality disorder lives in a world where everything is viewed in extremes of ‘good’ or ‘bad’. Underneath the defense mechanisms, there invariably lies an extremely FRAGILE SENSE OF SELF-ESTEEM. Therefore, the individual really feels EXTREMELY VULNERABLE and tends to have an overwhelming need to PROTECT HIM/HERSELF FROM ANY THREAT TO HIS/HER EXTREMELY PRECARIOUS SELF-IMAGE. The person with the disorder has a disturbance of the basic structure of the self.
THE THERAPEUTIC APPROACH TO TREATING NARCISSISTIC PERSONALITY DISORDER :
Research suggests that one of the main keys to psychotherapeutic intervention is an acknowledgment of the person’s pain, their overwhelming sense of their own vulnerability and their consequent desperate need to protect themselves from further psychological suffering. The therapist needs to reassure them that their defenses have been identified as self-protective, and, as such, are understandable.
I hope you have found this post of interest. Please leave a comment if you would like to – I will respond asap.
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