Recommendations for psychotherapeutic management of patients with narcissistic personality disorder are based on clinical experience; however, little attention has been given to the role of couple therapy with these patients. A stable intimate relationship appears to positively affect the course and outcome of narcissistic personality disorder.
The DIN indicated that the following characteristic were significantly more common among the patients with narcissistic personality disorder: a sense of superiority, a sense of uniqueness, exaggeration of talents, boastful and pretentious behavior, grandiose fantasies, self-centered and self-referential behavior, need for attention and admiration, arrogant and haughty behavior, and high achievement (Ronningstam and Gunderson 1990).
A child without a healthy sense of who they are has unhealthy narcissistic traits and may go on to develop narcissistic personality disorder.
In healthy adults self-limitations and disappointments are tolerated and self-esteem is steady. In unhealthy narcissism, disturbances in self-esteem trap the individual in a shallow world of overconfidence and self-preoccupation with no warm and loving relationships.3
As noted in the first chapter of this handbook, recent data indicate that the rate of narcissism is higher than ever among college students (Twenge & Campbell, 2009). Research also indicates that the prevalence of Narcissistic Personality Disorder (NPD) is quite high in the general population, with a rate of 6.2% (Pulay, Goldstein, & Grant, 201 1).
This paper reviews current theories concerning the development and treatment of Narcissistic Personality Disorder, and introduces the use of Ego State Therapy for its treatment. The ego state model of treatment will be described and demonstrated with case material. Initially ego states that reveal the grandiosity will be accessed. As therapy progresses, ego states that hold the underlying feelings of emptiness, rage, and depression are able to emerge.
Narcissistic personality disorder first appeared in DSM in the third edition. Its inclusion was stimulated in large part by contributions of psychoanalysts such as Kernberg, who continued in the tradition of a conflict-based ego psychology and object relations approach, and Kohut, who opted for a deficit-based theory of personality development postulating that narcissistic pathology resulted from the child's repeated experiences of parental empathic failure.
The term narcissistic personality disorder was introduced to the literature by Kohut (1968), who is considered a major theorist in examining the concept of NPD (Akhtar & Thomson). For the purposes of this paper, Kohut's self-psychology approach is used to provide a theoretical perspective in understanding individuals with NPD.
Q-factor analysis identified three subtypes of narcissistic personality disorder, which the authors labeled grandiose/malignant, fragile, and high-functioning/exhibitionistic. Core features of the disorder included interpersonal vulnerability and underlying emotional distress, along with anger, difficulty in regulating affect, and interpersonal competitiveness, features that are absent from the DSM-IV description of narcissistic personality disorder.
Surveying a wide representation of 35,000 Americans, they discovered that "nearly 10 percent of twentysomethings reported symptoms of narcissism, compared to just over 3 percent of those over 65." And in an age of confessional blogging, and constant Facebook and Twitter updates, that figure isn't hard to believe.
Narcissism is a trait that exhibits “grandiosity, an inflated sense of self-importance, and over-estimations of uniqueness.” If severe, it can also be a personality disorder recognized by the Diagnostic and Statistical Manual of Mental Disorders
The trait has some positive qualities, such as abundance of self-esteem and positive sense of self. Narcissistic people characteristically tend to overestimate their intellectual abilities, attractiveness and positive personality traits, wrote Konrath.