NPD Article - Lecture 7 Flashcards
(30 cards)
Why is there diagnostic confusion regarding NPD?
Highly variable presentation and the wide range of severity
What is the problem with the DSM’s definition of NPD?
Too narrow:
Characterized by a pervasive pattern of grandiosity, need for admiration, entitlement, and lack of empathy
- Fails to cover important characteristics of the disorder
- Is a priori, doesn’t address underlying psychological structures
Subtypes of NPD
What are the 3 main subtypes of NPD?
- Grandiose
- Vulnerable
- High functioning
Grandiose
- Characterized by grandiosity, attention seeking, entitlement, arrogance, and little observable anxiety
- socially charming, despite being oblivious to the needs of others, and are interpersonally exploitative
Vulnerable
- Distressed, hypersensitive to the evaluations of others while chronically envious and evaluating themselves
in relation to others - Interpersonally these individuals are often
shy, outwardly self-effacing, hypersensitive to slights
How can you conceptualize the two above subtypes in terms of admiration and rivalry?
- Admiration = Grandiose subtype
- Rivalry = Vulnerable subtype
High-functioning
- Grandiose, competitive, attention seeking and sexually provocative, while demonstrating adaptive functioning and using narcissistic traits to succeed
- Might no even appear at first that they have a disorder
What are the core psychological features that define NPD?
- Deficits in self-definition, self-esteem and affect regulation
- Deficits in consolidation of internal goals and standards as core features of the disorder
- Interpersonal relationships are “functional”, serving to support the sense of self and/or to provide personal gain, and capacity for intimacy is lacking
What is the relationship between sense of self and NPD?
Sense of self is very fragile and that’s why people try to maintain a grandiose view of one’s self as exceptional
- Maintaining a grandiose sense of self can provide a more or less stable self-experience for the individual
- A cost: Retreat or denial of realities that do not support grandiosity, leaving the individual excessively reliant on external feedback to support both positive self-regard and self-definition
What bipolar problem arises then in people with NPD?
They have a profound need for others to
support their sense of self and also to help with self-esteem regulation. On the other hand, genuine engagement with others can threaten the stability of the grandiose sense of self, by confronting the individual with the painful reality that others have attributes that they lack
Comorbodities
What are the most frequent comorbid disorder in NPD?
SUD, Bipolar, and other PD’s
- PD’s: Histrionic, BPD, Schizotypal, ad ASPD
-> ASPD has the most detrimental consequences on prognosis
Each subtype of NPD is related to what comorbid disorders?
- Grandiose: SUD, ASPD, and PPD
- Vulnerable: Depression, Anxiety, Suicide
Clinical presentation and challenges
What is unique to NPD compared to all other disorders?
spans the broadest spectrum of severity and functioning.
Therefore it is useful to distinguish not only
between grandiose/overt and vulnerable/covert clinical presentations, but also among different levels of severity of narcissistic personality disorder
What can help in diagnosing people with NPD?
Their description of significant others.
- Usually the descriptions are dismissive or derogating, as well as superficial or vague
- Tend to describe others in terms of how similar they are to them
What are some challenges in treating NPD?
- Limiting patients destructive and self-destructive behavior
- Necessary to minimize secondary gains -> insist that patients find proper employment and employ the help of family members as well
Assessment
What’s the best way to diagnose NPD?
(Because of subtle presentations sometimes and the interpersonal difficulties) a systematic clinical interview may be the most reliable way to diagnose
(Specifically Kernberg’s structured interview)
What are the different levels of functioning present in NPD?
- High functioning: achieve the admiration necessary to gratify their
grandiose needs and function successfully.
-> susceptible to breakdowns in response to setbacks or advancing age - Middle level of functioning: Can function adequately or even professionally well, or they might refuse to work if they don’t have narcissistic supply
- Lower level of functioning: Lack of engagement in the world, frequently oscillate between grandiosity and suicidality
- Malignant functioning: take pleasure in sadism and aggression towards others, antisocial behavior and paranoid features
How might a clinician react to someone with NPD?
- Pressured to provide a magic cure
- Feeling belittled and devalued
- Feeling treated like someone who is incompetent
- Feeling ignored and unrecognized the whole time
Differential Diagnosis
What is a difficulty regarding what diagnosis to make in people with anxiety or depression?
If the symptoms reflect a comorbid diagnosis are primarily an expression of personality pathology
What are similarities and differences between mania and NPD?
- Similarities: mimic features of grandiose narcissism
- Differences: admiration seeking
and devaluation of others characteristic of narcissistic personality disorders are absent in mania
What is the relationship between NPD and SUD?
Chronic substance abuse can affect psychological functioning to simulate NPD; the individual with a chronic substance use disordeR may become exploitative, self-focused, lacking in empathy, and ruthless, often in conjunction with antisocial features.
What is the relationship between NPD and depression?
Symptoms associated with depression overlap with features of vulnerable NPD
What PD’s are mostly diagnosed alongside NPD?
BPD, ASPD, HPD
Similarities between NPD and BPD?
Impulsivity in the sense of self along with the impulsivity and self-destructiveness of BPD
