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Narcissistic Personality Disorder

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The Authentic Recovery Center is a dual diagnosis rehab located in Los Angeles, California. We offer multiple levels of care and specialize in providing highly individualized clinical treatment. If you would like to learn more about our program call 1 877 415 4673 now.

Learning More

This section of the website will provide a broad overview of Personality Disorders. Since disorders of this nature are diagnostically broken down into several categories, the following will focus on a single sub-category, Narcissistic Personality Disorder, outlining the basic information that is pertinent to this specific classification. Discussion will include a general summary of Personality Disorders, followed by a brief overview of the diagnostic criteria for Narcissistic Personality Disorder, its symptoms, and finally treatment methods.

General Overview of Personality Disorders

Personality Disorders are a variety of personality types, distinguished by specific sets of behaviors that deviate from what are considered to be spectrums of normal functioning. Disorders of this kind are marked by severe and chronic disturbances in the overall development of the personality, with increasingly dysfunctional cognition and behavioral tendencies. Invariably these disturbances manifest as perpetual disruptions in personal relationships and come to affect virtually every aspect of an individual’s life.

One of the distinctive features of Personality Disorders is the intractability of the individual’s perceptions and responses. The individual’s patterns of behavior do not vary from situation to situation, but remain constant, and typically only make sense to the person. Overtime this develops into a set of traits that are completely maladaptive and which generate constant conflict, depression, or anxiety. One of the hallmarks of Personality Disorders is an inability to sustain personal relationships on any level, attended by the presence of constant upheaval in the personal histories of the sufferer. It is assumed that the emergence of these behaviors has their origins in childhood development, and is often traced back to the quality and kind of relationship the person experienced with a primary care-giver. The rigidity of the behaviors, reactions, and characteristics is striking, and applies to all varieties of the disorder.

What is Narcissistic Personality Disorder?

Narcissistic Personality Disorder (NPD) is a condition that is characterized by the presence of a distorted sense of one’s importance, coupled with a pervasive need for admiration. Individuals who have Narcissistic Personality Disorder operate under the delusion that they are smarter, wiser, more valuable, and superior to others. They have no regard for other’s feelings, wants, or emotional states, and tend to perceive the world and those about them as items to be utilized in their quest to perfect themselves in their own eyes.

There exists in the make-up of these people a marked trend toward grandiose thinking and an absence of the kind of empathy for others that real relationships demand. There is also a tendency to see themselves as vitally importance in virtually every scenario, which occurs in tandem with a casual disregard for the feelings and needs of others. Their presentation is frequently distinguished by a haughty attitude or demeanor, expressed in conjunction with patronizing or contemptuous attitudes towards those in their midst. These traits can be so dramatically developed that NPD is often characterized in much the same way as Antisocial Personality Disorder and Borderline Personality Disorder

Symptoms for Narcissistic Personality Disorder

Symptoms of Narcissistic Personality Disorder follow a predictable trend, although, like other mental health conditions, there are always nuances based upon, and shaped by, the subtleties of the individual’s character. Symptoms include:

  • Constant ideation regarding the acquisition of power.
  • Hypersensitivity; being easily offended.
  • A conviction that one is better than others.
  • Ideation regarding the acquisition of success, in addition to a need to perceive themselves as beautiful.
  • Boasting unrealistically about both achievements and goals.
  • Remaining in a state of anticipation regarding praise and adoration.
  • An inability to recognize others’ feelings or to empathize.
  • Methodically, coldly, taking advantage of others.
  • Operating under the belief that others need always follow their wishes or demands.
  • Fostering intense jealousy about other people’s accomplishments.
  • Inability to nurture truly intimate relationships.
  • A conviction, secretly kept or published, that they are special and destined for greatness.
  • Striving to achieve unrealistic goals.
  • Harboring the belief that others are in fact jealous of them.
  • Cultivating an appearance of distance; being removed or aloof or tough.

It should be noted that although these features might in some circumstances be regarded as healthy – e.g., traits associated with confidence or leadership skills – with the Narcissist they are prevalent in a way that absolutely cripples their ability to truly bond with others. With the Narcissist, these features are almost always destructive both in how they develop and also how they express themselves.

In addition to the traits just noted, other symptoms might include an overwhelming need to dominate situations and conversations; to dismiss out of hand the opinion of others; and to operate under the delusion that others need be grateful for the attention lavished upon them by the Narcissist.  Frequently, Narcissists react to any kind of criticism with outrage, rage, or contempt. Gross entitlement guides most decision making, and there is always the conviction that special treatment should be forthcoming, regardless of the situation.

Treatment for Narcissistic Personality Disorder

Narcissistic Personality Disorder is typically treated with one of three modes of individualized Psychotherapy: Self psychology, Schema Therapy, and Individualized Psychotherapy. Each style makes specific assumptions about the disorder, and each has its own set of clinical priorities (more in a moment). But treating this particular population is fraught with difficulties, not the least of which is the fact that frequently the therapy sessions become a forum in which the disorder ends up being reinforced by the very dynamics that seek to undo it; in other words, frequently the therapy sessions become a stage upon which the Narcissist gets the attention they so crave, simultaneously relegating the therapist to the role of unwitting audience member.


Self psychology was pioneered by a psychiatrist named Heinz Kohut, who felt that Freud’s classic ideas about conflict, drive, id, ego, and super ego, did not address the Narcissist’s core issues. Kohut’s theories assert that the personality is broken down into three components (what he referred to as a tripolar model); and that the three entities can only properly develop when they occur within healthy, intimate, relationships. It is essential for healthy emotional transactions to occur for the ego to properly develop. In other words, Narcissistic Personality Disorder is the result of intimate deficits in primary-care relationships. Through the medium of the clinical relationship, in which a trusting, safe environment is cultivated, the therapist and client attempt to restructure the fractured parts of the ego, and thus refashion a whole.

Schema Therapy

Schema Therapy combines several therapeutic styles, including Cognitive, Behavioral, and psychodynamics. It is typically employed when other forms of therapy have failed; e.g., Dialectical Behavioral Therapy with a Borderline client. It operates under the premise that personality disorders develop as a result of some early trauma, often pre-cognitive or below the conscious level of memory. These early traumas manifest as what are called attachment disorders, and usually express themselves in gross disturbances in the personality, coupled by an inability to retain what is called ego constancy. Schema Therapy focuses on developing trusting relationships with the therapist, whereby re-parenting occurs, with the end-goal being diminishment of the symptom severity.


As is the case with other personality disorders, there is no medical or pharmacological treatment that addresses the condition itself. Instead, medications are prescribed to address certain symptoms such as anxiety; or to treat symptoms stemming from secondary conditions, such as depression. Because of the high rate of or co-occurring disorders amongst this population, if medications are indicated, care must be taken. In the case of dual diagnosis, the prescribing physician will have to suss out what symptoms are the result of which condition. For example, in the event that features of depression are present, some form of SSRI is employed. SSRIs are a class of anti-depressant that targets the part of the brain responsible for regulation of serotonin.

The SSRIs typically prescribed include:

  • Prozac
  • Paxil
  • Lexapro
  • Zoloft

An additional concern regarding medications and NPD is the high rate of addiction that co-occurs. This becomes problematic for people with NPD who suffer, for example, from some form of anxiety, in which case the clinician must be very cautious if prescribing an anti-anxiety medication such as a benzodiazepine.

A Special Note Regarding Benzodiazepines, Narcissistic Personality Disorder, and Dual Diagnosis:

As previously stated, a dual diagnosis refers to a condition in which an individual’s addiction occurs simultaneously with another mental health problem, each aggravating the other and both contributing to the problems of the individual.  In situations where a dual diagnosis has been made – especially where NPD has been diagnosed in tandem with an addiction – the use of benzodiazepines must be closely monitored. Unlike anti-depressants, benzodiazepines have a euphoric component and abuse potential that generally makes them inappropriate for treating a population with histories of addiction.

Because of these complications, most physicians specializing in treating dual diagnosed clients will only prescribe benzodiazepines in a very restrictive way, for the shortest duration possible. Given these considerations, dual diagnosed individuals have a better chance of receiving comprehensive care from treatment teams that are specifically trained to deal with individuals who suffer from co-occurring disorders.

The benzodiazepines most commonly prescribed to NPD sufferers for short-term treatment are:

Treatment Goals for Narcissistic Personality Disorder

Although the goals of any treatment will be tailored to the needs of the individual, people suffering from NPD will have fairly predictable goals for treatment outcome. Therapists focus on the self-deception, shame and superiority feelings that attend acting out, and must view the disorder as a dialogue that occurs between two distinctive components of one personality: on the one hand a crippling sense of inferiority, on the other hand, a pervasive sense of superiority and unrealistic entitlement.

Treatment goals might include:

  • Strengthening trust and attachment as a means of reestablishing ego boundaries.
  • Monitoring abusive behavior.
  • Developing what is referred to as Emotional Intelligence Training; a technique in which the individual is taught to self-soothe.
  • Working on Developmental Gap work, which includes focusing on developmental deficits.
  • Increased tolerance regarding the opinions of others.
  • Improved skills working with others.

Like treatment for other personality disorders, NPD treatment goals need to take into account, not just the nuances of the condition, but also the nuances of the individual. To this extent the goals of treatment should not run opposite the fundamental make-up or temperance of the individual. The topic of Narcissistic Personality Disorder is vast, and not easily summed up in one article. Education and awareness are the first steps to acquiring help. Take the time necessary to keep yourself informed about latest practices and current treatment options. Hopefully this article will assist giving you a foundation of knowledge that will make selecting the correct course of treatment easier to determine.

Call to Learn More about the Authentic Recovery Center

Many programs profess to be able to attend to dual diagnosis, but trying to find any information about co-occurring disorders on their websites can prove difficult. The key to effective treatment for dual diagnosis issues is to approach the problems from a clinical standpoint – with a seasoned team of clinicians. If you would like to learn more about the Authentic Recovery Center call 1 877 415 4673 now. Our approach to treatment is both comprehensive and individualized – two ingredients you really can’t afford not to have if you want a successful rehab experience.

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