What is Narcissistic Personality Disorder?

Although PCH Treatment Center avoids stigmatizing labels like “narcissist” or “Narcissistic Personality Disorder (NPD)” , we do provide treatment for persons who have experienced trauma or neglect in childhood and who manifest certain behavior and personality features consistent with the concept of narcissism. These features include an exaggerated sense of self-importance or uniqueness, a preoccupation with receiving attention, overvaluing of their own achievements and talents, and focus upon the “special” nature of their problems. In this construct, a fragile self-esteem is revealed by a preoccupation with how others regard them. Features of narcissism include a preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love. There is also a need for constant attention and admiration, and either a cool indifference or feelings of rage, inferiority, shame, humiliation, or emptiness in response to criticism, indifference of others, or defeat. Examples of behaviors consistent with narcissism include:

  • Entitlement, or the expectation of special favors without assuming reciprocal responsibilities (surprise and anger at people when they do not do what they want).
  • Interpersonal exploitativeness, or taking advantage of others to indulge their own desires or for self-aggrandizement (a disregard for the personal integrity of others).
  • Relationships that characteristically alternate between the extremes of over-idealization and devaluation.
  • Lack of empathy, or the inability to recognize how others feel (unable to appreciate the distress of someone who is seriously ill).

It is important to note that these traits exist on a continuum, with some manifesting milder forms and others a more extreme position.

What causes Narcissism?

Narcissism is believed to arise primarily from early neglect or trauma in childhood, as no specific genetic pattern has been demonstrated. Developmentally, narcissistic traits appear commonly in adolescence. While most people outgrow these traits, those who develop the characteristics maintain these issues from adolescence through adulthood.

Narcissism originates from experiences in childhood such as loss of a father figure, an excessively condescending or critical environment, or unpredictable or unreliable caregiving from parents. Other forms of childhood psychological trauma, including physical or sexual abuse increase the risk of developing interpersonal problems. Chronic insomnia, overworking, exposure to high levels of stress, substance abuse, medical problems, and difficulties with family or other interpersonal relationships can exacerbate the symptoms of trauma related personality issues.

How is Narcissism diagnosed?

Narcissism (“narcissistic personality disorder”) in adults is recognized by severe disturbances of interpersonal relationships. Younger persons with narcissism display grandiosity, which tends to be less pronounced in adults with “stable” Narcissistic traits. Unfortunately, symptoms of this personality type tend to be vague and difficult to isolate. For example, lack of empathy and exploitative interpersonal relationships are hallmarks of narcissism, but they can be present with other psychological disorders.

Establishing the diagnosis of Narcissism may be difficult. Narcissists rarely enter treatment and when in treatment feel they are wasting their time. They may leave treatment before it is completed. Depression and substance abuse (especially alcohol, marijuana or cocaine) are also prevalent.

How does PCH Treatment Center treat Narcissistic Personality Disorder?

PCH Treatment Center offers a unique way to help people with Narcissism. When a Client enters PCH Treatment Center, they are carefully assessed by our highly qualified treatment team. While we avoid stigmatizing labels, we do understand the role of early childhood challenges that shape personality types, and how this manifests with maladaptive behaviors in adulthood. Our goal is to make a diagnosis and treatment plan, incorporating our understanding of developmental psychological trauma, and organizing our most relevant treatment modalities within the treatment plan. We often end up discarding inappropriate diagnoses and previous treatment constructs. The PCH psychiatry team are also experts in psychopharmacology. Our goal is to minimize or eliminate medications (when possible), and it is extremely common for us to find clients arriving who are overmedicated or inappropriately medicated, requiring our guidance.

In conjunction with individual psychotherapy, we offer somatic experiencing, group therapies such as trauma timeline, mentalization, mindfulness-based stress reduction, Dialectical Behavioral Therapy (DBT), anger management, sleep management, and psycho-education. Neurofeedback is also an important adjunct. Holistic therapies including trauma-informed yoga, meditation, and when appropriate, acupuncture and massage therapy are also utilized for recovery and healing. Family therapy groups are available which incorporate family members or significant others into the Client’s treatment environment when indicated. This can be extremely effective in dealing with personality challenges and maladaptive interpersonal behaviors.

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