Narcissistic Personality Disorder Debbie Kurtz Wake Forest University

Narcissistic Personality Disorder Debbie Kurtz Wake Forest University Department of Counseling ABSTRACT Narcissistic Personality Disorder (NPD) is a debilitating condition marked by lack of empathy, inability to form intimate bonds, sense of self-entitlement and hypersensitivity to criticism or defeat. NPD manifests in two forms, the grandiose form and the vulnerable form. Research supports self-esteem as being at the core of narcissism formation and the parental relationship in early. childhood as a defining factor in self-esteem formation. It appears that we need a better understanding of what type of self-esteem dysfunction influences the development of grandiose narcissism verses formation of vulnerable narcissism; and the influence of caregiver rejection on self-esteem and narcissism formation. METHODS I initiated my search on the Wake Forest University , Z Smith Reynold’s Library website. This site allowed access to two data bases; Pub. Med and Psych. INFO. § Psych. INFO search parameters include peer reviewed articles, journal articles, book and e-books, published from 2009 to the present. § Initial keyword search on Psych. INFO included the terms: “vulnerable narcissism”, “self-esteem development”, “narcissistic injury”, adolescent narcissism”, “childhood abandonment”, “parental rejection. ” § Article citations lead to additional keyword terms: “covert and overt narcissism”, “parental bonding”, “implicit self-esteem. ” § A search on Google Scholar did not provide results that were within acceptable parameters. § Journals that provided the most relevant information were the Journal of Personality and Mental Health; The Journal of Personality and Individual Differences and the Journal of Social and Clinical Psychology. § The Diagnostic and Statistical Manual V text which supplied a comprehensive description of NPD, including diagnostic criteria and features, prevalence, development course and differential diagnosis. INTRODUCTION NPD is confusing, difficult to treat and disruptive to the lives of those who have this condition. Individual’s with NPD do not establish deep, intimate bonds with others. Their sense of entitlement, arrogant self-focus and lack of sensitivity of the wants and needs of others make them difficult to work with, work for and be in relation with. They see others as tools to advance themselves or increase social status or gain wealth. Lacking empathy they make poor parents- causing trauma to their children and spouses (Brummelman, Thomaes & Sedikides, 2015). This disorder is difficult to diagnose. One of the most striking and consistent findings among personality disorders is that of comorbidity; it is far more common for an individual to have cooccurring rather than single personality disorder diagnosis, and NPD has typically been one of the worst offender in this regard (Morey, Stanger, 2012). Adding to the confusion are many different titles describing pathological narcissism. Dr. Aaron L. Pincus created the titles of grandiose and vulnerable; while Dr. T. Millon applied the terms overt and covert- referring to the style of expression of emotional injury. Adaptive and maladaptive, are additional terms, that refer to the progression of the disorder as one ages. Recent research is beginning to question whether grandiose and vulnerable narcissism point to NPD as a spectrum disorder. FACTS: • • NPD is estimated to affects approx. 2% of our general population. 50%-75% of those affected are male High rate of comorbidity with other personality disorders. NPD is associated with anorexia nervosa, substance use disorders, histrionic, borderline, antisocial and paranoid personality disorders. (American Psychiatric Association, 2015). DISCUSSION RESULTS RECOMMENDATIONS FOR FUTURE RESEARCH • Understand why there is a greater influence on narcissism formation among children raised with an overvaluing parenting style verses those raised by cold, rejecting parenting style. • The effects of cold parenting style related to parent child gender influence on self-esteem levels and narcissism. Is Parenting Style the cause of Narcissism? INSIGNIFICANT influence. • Parental Coldness NO Influence. - • Parental Overvaluation w/ Coldness - SIGNIFICANT INFLUENCE. • Further study on childhood parental attachment, abuse and affects of temperament on formation of vulnerable narcissism would be beneficial. New Research: Low Self-esteem and excessively high self-esteem are thought to be at the core of NPD. • Narcissism as a spectrum disorder as expressed by co-occurring grandiose and vulnerable themes. • Overvalued Childs' use of narcissism as a defense mechanism to parental disappointment. Two Separate Constructs: Narcissism and self esteem are seen by some researchers as two similar but different constructs. They are similar in that they arise from the internalization of regard from significant others; they are different in that they arise from distinct forms of regard. Forms of Regard: • Overvaluation – “ I am superior, I’m special” = Narcissism Self–esteem’s effect on determining NPD type formation. vs. • Parental warmth- “I am worthy” = High Self -esteem • Narcissism – relates to others in a hierarchical, vertical manner. • High Self-esteem – relates in an equal, horizontal, healthy manner. (Brummelman et al, 2015). A 2016 study by Di Pierro, Mattavelli and Gallucci focused on defining the effects of implicit self-esteem (ISE) and explicit self esteem (ESE) and their effects on grandiose narcissists (GN) and vulnerable narcissists (VN). Findings: • GN = ESE levels increased when combined with high or medium ISE. • GN= ESE levels were not effected by low ISE. • VN= Displayed low ESE regardless of the level of ISE. ESE is relatively stable. it will not decrease but will increase if the ISE is at a higher level. Supporting the idea that excessively high selfesteem and feelings of superiority are at the foundation of GN. RESEARCH POSTER PRESENTATION DESIGN © 2011 www. Poster. Presentations. com • Cold parenting style, alone, does not lead to formation of narcissism ; as reported by a quantitative study. Conversely, a qualitative study pointed to cold/distant mothers and poor relationship with their sons aiding creation of narcissistic tendencies. • Leading some to consider NPD as a personality disorder on a spectrum ranging from healthy, adaptive to maladaptive. • Vulnerable Narcissist – They are more likely than the grandiose form to seek counseling. Typically seeking help for depression and anxiety caused by internalized negative self-perception, selfcriticism, anger, shame, dysphoria and interpersonal sensitivity (Hill, Green, Arnau, Sisemore & Myers, 2011). • Parental Overvaluation – • The Grandiose narcissists are not easily influenced. Making them resistant to treatment. • VN and GN are opposites. Vulnerable form identifies with Neuroticism, the Grandiose form identifies with Extroversion. • Grandiose Narcissist – They are initially very charming and make friends easily. Over time, the arrogant, self-centered , entitled and exploitive behaviors reveal themselves and relationships fall apart. Findings: • Grandiose narcissism is linked to overvaluing parenting style that teaches the child that they are special and superior to others. • Vulnerable narcissists are more likely to seek treatment – usually for depression and anxiety. Characteristics of NPD: • A 2006 study by Otway and Vignoles entitled “Narcissism and Childhood Recollections” researched parental overvaluation verses parental coldness as it relates to NPD Characteristic formation. We are sure of a few things: • Vulnerable narcissism is linked to a highly fragile self-perception. The causation is still unsure. It is most likely multi-faceted. (Life experience, temperament, parental influence). • Healthy Narcissism exists and is a part of everyone it allows one to compete in sports, climb the corporate ladder and be confident enough to ask the girl to marry you. Helps you to move forward in life and create healthy relationships. • NPD, specifically, has been discussed as a disorder that arises out of early, adverse experiences with caregivers (Maxwell, Huprich, 2014). Narcissism has been recognized for thousands of years. Even so there is still much to learn about NPD. SELECTED REFERENCES American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5 th ed. ). Washington, DC: Author. Brummelman, E. , Thomaes, S. , Sedikides, C. (2015). Separating narcissism form selfesteem. Current Directions in Psychological Science, 25(1), 8 -13. doi: 10. 1177/0963721415619737 Di Pierro, R. , Mattavelli, S. , Gallucci, M. , (2016). Narcissistic traits and explicit selfesteem: The moderating role of implicit self-view. Frontiers in Psychology, 7(1815), 1 -9. Is NPD as a Spectrum Disorder? In a 2012 study by Houlcroft and Munro, further detailed the distinctions and correlates between GN and VN; • GN related positively to Extroversion and negatively to Neuroticism. VN related negatively to Extroversion and positively to Neuroticism. They are opposites. • Implicit in this view is the notion of narcissism as a continuum phenomenon, from healthy and adaptive at one end of the spectrum, to pathological and severely maladaptive at the other (Kealy, Rasmussen, 2011). Kealy, D. , Rasmussen, B. , (2011). Veiled and vulnerable: The other side of grandiose narcissism. Clinical Social Work Journal, 40, 356 -365. Maxwell, K. , Huprich, S. , (2014). Retrospective reports of attachment disruptions, parental abuse and neglect mediate the relationship between pathological narcissism and self-esteem. Personality and Mental Health, 8, 290 -305 dio: 10. 1002/pmh. 1269 Otway, L. J. , Vignoles, V. L. , (2016). Narcissism and Childhood Recollections: A quantitative test of psychoanalytic predictions. Personality and Social Psychology Bulletin, 32(1), 104 -116