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Narcissistic Personality Disorder  is a mental disorder that is considered to be an impairment in personality functioning, the presence of pathological traits, lack of empathy for others and a need for admiration.  This type of personality disorder has some related disorders such as antisocial behaviors, interpersonal exploitation and envy. There have been ongoing discussions on how this type of behavior is processed in the brain. It is not clearly known what causes Narcissistic Personality Disorder, however, as with other mental disorders, the cause is likely very complex. The cause may be linked to a dysfunctional childhood, such as excessive pampering, extremely high expectations, abuse or neglect. It could also be related to genetics or psychobiology which is the connection between the brain and behavior and thinking . This may play a role in the development of Narcissistic Personality Disorder. With the help of various clinics and independent work studies, I was able to focus on the possible link between the brain behavior and thinking of a person with Narcissistic Personality Disorder. This mental disorder, according to the research presented, was difficult to diagnose and isolate it from other personality disorders. However, there were some tests done based on predetermined symptoms that has lead to treatment and continuous long-term care. Given the theories and current practices in the medical field today, this disorder will continue to be diagnosed more precisely in order to render a more narrow treatment to patience with this Narcissistic Personality Disorder.

Introduction

Like any other types of mental illness, Narcissistic Personality Disorder is primarily driven by dramatic emotional behavior, which parallels antisocial and borderline personality disorders. The symptoms are numerous in nature and most of us may have experiences with these types of personalities without quite understanding what may have been the driving forces behind the behaviors. Some of the most common symptoms  are; believing you are better than others, exaggerating achievements, needing constant praise, taking advantage of others or being envious of others’ achievements if they are perceived to be better than yours.

This report will focus on the primary symptoms,  causes,  tests and the treatment options for someone with this personality disorder. Additionally, we will take a look at  how the brain of an individual deals  with processing emotions, trying to correlate the relationship between behaviors and emotions. Even though there has not been concrete evidence these behaviors are all driven by neurological functions, there is enough to make a qualified assumption these behavior types are driven by some specialized brain functions. However, underneath all this behavior there lies a fragile self-esteem. They may have trouble handling anything that is perceived as criticism, have a sense of secret shame and humiliation and thus display behaviors  in order to make themselves feel better. A person with this disorder may react with rage or contempt in efforts to belittle the other person to make themselves appear to be better.

We will look at the commonly known ‘Dr. Jekyll and Mr. Hyde’ personalities and how a person who is narcissistic can start out being very likable and friendly at first then change their behaviors when an opportunity presents itself.

Finally, we will look at current discussions in the psychiatry environment and what plans are in place to continue further discussing this disorder, including any non-conventional treatments, including taking a look at the revised Diagnostic and Statistical Manual of Mental Disorders (DSM) Revision V.

Main Theme:

Identifying Symptoms:

Individuals with Narcissistic Personality Disorder come across as conceited, boastful or pretentious. They often monopolize conversations and belittle or look down on other people perceived as inferior. They seem to have a sense of entitlement and when they don’t receive the special treatment to which they feel entitled, they may become very impatient or angry. They may insist on having “the best” of everything and justify this by claiming they are taking care of themselves first, regardless of the needs of others around them.

Factors and Causes:

Narcissistic Personality Disorder is rarely identified which limits the studies needed to further evaluate subjects. However, it affects more men than women. It often begins at early adulthood. Although the cause is not fully known, researcher think that extreme parenting behaviors, such as neglect or excessive indulgent praise, may be partially responsible for the behavioral thinking associated with this disorder. Some studies showed that lack of affection, emotional abuse and unreliable care giving or learning manipulative behaviors can all be considered viable causes. In addition, children who learn from their parents that vulnerability is unacceptable may lose their ability to empathize with others’ needs. They may also mask their emotional needs with egotistical behaviors that make them seem emotionally strong by denying their true emotional feeling, thus having denial issues.

The Diagnosis:

The diagnosis of Narcissistic Personality Disorder is based on signs, symptoms and through psychological evaluations beginning with a series of well designed questions. Some features of Narcissistic Personality Disorder are similar to those of other personality disorders. It’s possible to be diagnosed with more than one personality disorder at the same time.

Even though there is no current laboratory tests used to diagnose this disorder, there is a physical examination of the person, including a test of their brain functions. An individual must meet special criteria in a Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association used widely by mental health professionals.

To diagnose Narcissistic Personality Disorder, some criteria must be met. First, it must be identified that the affected person is excessively making references to others to demonstrate self appraisal and self deflations. These two extreme emotions demonstrate lack of self esteem and potential self-identification issues. Next, if a person is setting goals based on approval of others or acceptance of others, then the person becomes unaware of his or her own motivations, rather they are more focused on others perception of them with the achieved goals. In addition, a lack of empathy or the  need of others unless there is a relationship between others’ needs and oneself. Furthermore, intimate relationships are largely superficial unless that relationship fulfills the needs of the affected person with the disorder.

Once a person is diagnosed with the disorder, treatment is centered on psychotherapy. There is currently no special medication to treat this disorder, but if symptoms of depression or anxiety is present, medications such as antidepressants may be administered. Some types of therapy can include cognitive behavior therapy, family therapy or group therapy.

Treatment Options:

As treatment is administered, the next stage is prevention. Because the cause of Narcissistic Personality Disorder is unknown, there is no known way to prevent the condition with any level of certainty. However, early treatment is the best option for this disorder. A parent should be cognitive of their child’s behaviors and be able assimilate that the child has some issues and behaviors that are different from other children in the family or children in a peer group. How we deal with inner pain and emotional insecurity is crucial in all culture types. There are some essential facts that stand out in this disorder; genetically, men act out more of these symptoms, they are inherently more violent and they usually possess more criminal type tendencies.

There are several types of therapy treatments for those with Narcissistic Personality Disorder. These types of treatment may be helpful and can be used to treat other personality disorders as well. One of the treatments is cognitive behavioral therapy. This type of treatment helps a person identify unhealthy and negative beliefs and behaviors and replace them with more healthy and a more positive outlook. Another form of therapy involves the family. This is where the core family unit is brought into the sessions and discussions and exploration of conflicts or any other communication problems are discussed. Group therapy works well for other forms of personality disorders and works equally well for those with Narcissistic Personality Disorder. In a group therapy setting you are placed with people of similar conditions, including those who may have recovered or is on the road to recovery. This is a good way to learn by listening to others about their feelings, emotions and support they may have to offer.

As mentioned earlier, personality disorders can be difficult to diagnose or change thus therapy may take several years. There are short-term and long-term goals of psychotherapy treatments. The short-term goals for patients with this personality disorder is to focus on the underlying issues such as drug use, depression, self esteem or incidents in their life that may have the tendencies to cause shame. On the other hand, the long-term objective is to work on changing the personality so the patient may be able to change their patterns of thinking into one of a more realistic self-image.

The proper treatment can help a person with Narcissistic Personality Disorder to relate better with others and form more trusting and intimate relationships. They may be able to understand why they feel such emotions or need to belittle others in order to make them look good. Most importantly, they may learn what motivates them to compete or distrust others or perhaps despise themselves and others.

As discussed previously, we are able to see the symptoms, causes, tests, treatment options and possible results. As in many other types of personality disorders, the human emotions (Neil R. Carlson: Foundations of Behavioral Neuroscience. Chapter 10. Pages 275-300) consists of patterns of physiological responses and behaviors. These are accompanied by feelings, followed by reactions that have consequences for survival. Thus, the functions served by emotional behaviors are what guides the evolution of our brain and how our brain reacts and ultimately how we behave.

Emotional behaviors involve responses which are controlled by our neural systems  by behavioral, autonomic or hormonal components. Behavioral consists of muscular movements that are appropriate for a given situation such as running to rescue a small child in danger. Autonomic responses provide quick mobilization of energy for aggressive movement by adjusting the autonomic nervous systems, sympathetic or parasympathetic.  The hormonal component involves secretion by the adrenal medulla where there is an increased blood flow to the muscles causing nutrients stored in those muscles to be converted to glucose. Additionally, steroid hormones are also secreted to aid in the conversion to glucose.

A person with Narcissistic Personality Disorder or related disorders has to be constantly prepared emotionally to deal with a given situation where they feel threat or inferior.  If a person feels threatened, belittled or not measuring up, they might have reactions such as fear, anger, aggression or impulsive reactions or responses. Psychotherapist will have to look at all viable options in order to make a proper diagnosis leading to appropriate treatment.

Further exploration of this personality trait is quite often associated with Disassociative Disorder, commonly referred to as “Dr. Jekyll and Mr. Hyde”  personality. Some believe there is a connection between these two. Experts infer that maybe narcissism is a product of something traumatic happening to a child when they were very young, which prevented them from emotionally growing beyond a certain age.       Generally, the shift from Dr. Jekyll (good personality) to Dr. Hyde (bad personality) starts most frequently when the narcissistic feels the relationship is solid. It is very common with this Narcissistic Personality type, coupled with Dr. Jekyll and Dr. Hyde can produce devastating effects on those that love them. They can become severely jealous and insecure causing harms their partners. A combination of these two disorders can become deadly with long lasting damaging effects to those affected.

NPV Discussed

There are no firm statistics available in regard to the frequency of Narcissistic Personality Disorder given primarily by misdiagnosis. Psychologists say that 1% of the population is diagnosed with Narcissistic Personality Disorder, and 75% of the cases in therapy are men. This 1% statistic is gathered only from individuals diagnosed in therapy. Most narcissists are not in therapy, and even if they are, may not be diagnosed with this disorder. Psychologists freely admit this, as well as the frustration and impossibility of working effectively with this personality type.

It is estimated that up to 16% of society is severely narcissistic. It is further believed this is a much more accurate assessment than in previous admissions. What is frightening is: narcissists are extremely emotionally insecure, despite the outer charismatic personalities. Male narcissists are more successful in hooking and retaining their relationships, therefore creating severe psychological damage to women or their partners. The psychological society continues to explore this disorder in hopes of doing more studies and research in an attempt to understand this mental illness.

There is continuing discussions regarding the diagnosis and treatment of Narcissistic Personality Disorder. Currently, this disorder did make it into the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This revision replaced the DSM-4 with a measure of impairment and a list of pathological personality traits where clinicians can choose when diagnosing a patient. This change allows clinicians to get closer to isolating this personality dysfunction.

There are many who disagrees with this revision and assessment. There is claim that the decision was not based on a systematic or objective review of data and implementation may have a negative effect on personality disorder research. It is claimed that by having a list of traits in DSM-5, it will lack proper medical coding and record which can lead to poor future research and development of new treatment options. Nevertheless, the changes are currently being tested in the field and could warrant future discussions or changes to future revisions of the DSM.

Conclusion

The diagnosis of Narcissistic Personality Disorders is often very complex as these disorders frequently co-occur with each other and with other psychiatric categories of disorders. The exact cause of personality disorders remains uncertain but it is clear there are both biological, genetic factors and environmental, psycho-social factors that influence the disorder.

In conclusion, recent technological advancements and improvements to diagnostic methodologies have enabled researchers to study personality and personality disorders as never before. As a result, we now have a much greater understanding than before. Furthermore, this research has facilitated the development of several highly effective treatments disorders that are evidenced-based. As research continues, these treatment approaches will be further refined. Therefore, we can state with confidence there is hope and relief for people affected by this disorders, including their family members and loved ones.

References

Books

Carlson, N. R, (2001) Foundations of Behavioral Neuroscience, Eight Edition, Boston, MA.,

Pearson Education, Inc.

American Psychiatric Association, (1994) Diagnostic and Statistical Manual of Mental Disorders DSM IV  Criteria, DSM-IV-TR (Revision)

American Psychiatric Association, (2000) Diagnostic and Statistical Manual of Mental Disorders DSM-V (Revision)

Online Articles

Mayo Foundation for Medical Education and Research. 2011. Narcissistic Personality Disorder. Retrieved from http://www.cnn.com/HEALTH/library/narcissistic-personality-disorder/DS00652.html

Author Unknown. 2010.Narcissistic Personality Disorder. Retrieved from http://www.psychologytoday.com/conditions/narcissistic-personality-disorder

Melanie Tonia Evans. Year Unknown. Narcissism Understood. Retrieved from http://www.melanietoniaevans.com/articles/narcissism-understood.htm

Mayo Clinic Staff. 2011. Narcissistic Personality Disorder; Tests and Diagonisis. Retrieved from http://www.mayoclinic.com/health/narcissistic-personality-disorder/DS00652/DSECTION=tests-and-diagnosis

Joanna M Ashmun. Year Unknown. Narcissistic Discussed. Retrieved from http://www.halcyon.com/jmashmun/npd/traits.html

Simone Hoermann, Connie Zupanick, Mark Dumbeck. 2011. Personality Disorder Summary and Conclusion. Retrieved from http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=41589&cn=8

Author Unknown. Year Unknown. Dr Jekyll and Dr Hyde Narcissism-A Common These?. Retrieved from http://coparentingwithanarcissist.com/2012/10/dr-jekyll-and-mr-hyde/

S. Dingfelder. 2011.Narcissism and the DSM. Retrieved from http://www.apa.org/monitor/2011/02/narcissism-dsm.aspx

End of Report

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