Task 5 Flashcards
(29 cards)
DSM-criteria NPD
Pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in variety of contexts, as indicated by five (or more) of the following:
- Grandiose sense of self-importance (exaggerates achievement and talents, expects to be recognized as superior without commensurate achievements).
- Is preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love.
- Believes he/she is ‘special’ and unique and can only be understood by, or should associate with, other special or high-status people.
- Requires excessive admiration.
- Has sense of entitlement (unreasonable expectations of especially favorable treatment or autonomic compliance with his/her expectations).
- Is interpersonally exploitative (takes advantage of others to achieve own ends).
- Lacks empathy: Is unwilling to recognize or identify with feelings and needs of others.
- Is often envious of others or believes that others are envious of him/her.
- Shows arrogant, haughty behaviors or attitudes.
CRITERIA A
Moderate or greater impairment in personality functioning, manifested by characteristic difficulties in two or more of following areas Identity, Self-direction (= based on own gain), Empathy (= impaired ability to recognize others’ feelings and needs) and Intimacy (= superficial relationships).
CRITERIA B
– Both of following pathological traits Grandiosity (aspect of Antagonism) and Attention seeking (aspect of Antagonism).
Personality
Enduring patterns of perceiving, feeling, thinking about, and relating to oneself and environment.
Personality trait
Prominent aspect of personality that is relatively consistent across time and across situations.
Comorbididties
High rates of substance abuse and of mood and anxiety disorders; Increased rates of physical and sexual aggression, impulsivity, homicidal thoughts and suicidal behaviors
PSYCHODYNAMIC THEORIES
Psychodynamically oriented theorists suggest that symptoms of NPD are maladaptive strategies for managing emotions and self-views
They did not develop realistically positive view of themselves or adaptive strategies for handling stress/distress as children.
NPD is associated with history of childhood adversity, including physical abuse and neglect, as well as having parent who was abused or had mental health problem
COGNITIVE THEORIES
Cognitive theorists argued that some people with NPD develop unrealistically positive views about their self-worth as a result of indulgence and over-evaluation.
People with disorder develop belief that they are unique as a defense against rejection or unmet basic emotional needs by important people in their lives
Difference Antisocial -NPD
We can differentiate NPD from APD, by their sense of grandiosity and self-importance.
How does their tendency to create social situations in which they hope they can receive boosts to their self-esteem develop?
an interaction between inherited sensitivity to positive/desirable stimuli and aversiveness to negative/undesirable stimuli, combined with extreme forms of parenting (parental over-evaluation and overindulgence), or parental coldness, extremely high expectations or lack of support
Treatment
It is hard for a therapist to build alliance with people with NPD, due to narcissistic traits – Collaborative therapeutic approach must be emphasized
Therapist can use cognitive techniques to help client develop realistic expectations of their abilities and more sensitivity to others’ needs – This can be achieved by challenging their initially self-aggrandizing ways of interpreting situations.
Problems with DSm-5
+Criteria describe primarily manifestations of grandiose narcissism and ignore vulnerable aspects
Criteria describe primarily overt narcissism, missing the well-recognized covert representation.
Section 3
increase validity of diagnoses, by incorporating dimensional assessment.
Section III is based on two dimensional measures: Personality functioning & pathological personality traits (both are continuous).
Physiological base of NPD
Deficits related to PF grey matter
Deficits in GM volume seen in NPD affect their emotion regulation and emotional empathic processing, which can contribute to self-referential processing bias. Therefore, there seems to be neurological core for noticeable fluctuations in NPD’s internal control and control of emotions.
2. Measured psychophysiological reactivity in non-clinical people meeting DSM-IV NPD criteria. It identified sympathetic activation and negative reactions to happy stimuli, and indifference to fearful and sad stimuli.
Alexithymia
Ability to identify and describe feelings in words and to differentiate feelings from bodily sensations caused by emotional arousal. Relates to external events rather than one’s own subjective internal experiences.
Emotion recognition problems
NPD patients consider themselves sensitive to others’ feelings but were less accurate in recognizing emotional expressions in others, especially those related to fear and disgust.
emotion processing problems
Showed difficulties processing shame, fear, anger. Shame is rooted in complex developmental experiences (including disruptions in attachment). NPD is related to explicit conscious shame (evokes aggressive, critical, blaming actions) but even more to implicit unconscious shame (drives self-enhancing regulatory strategies). When NPD individuals go through experiences not possible to process with self-enhancing or avoiding strategies, suicide risk gets high. Aggression in NPD can be externally or self-directed (suicide).
Empathy ability in NPD is fluctuating
It can be influenced by interaction between deficits, capabilities and motivation. Overall, they tend to oscillate between susceptible awareness with intense negative reactivity (pain, intolerance, irritability) and obliviousness or ignorance.
Narcissism is a crucial moderator
of aggressive and angry reactions to rejection – It is an important factor in range of violent accidents.
violence in NPD
Violence is a strategy for gaining respect and retaliating against person or group who caused the self, insult or harm.
Narcicissts & love styles
Narcissism is associated with game-playing love style, which is a result of a need for power and autonomy.
- Eros
Physical passion and desire for rapidly escalating romantic involvement.
- Ludus
Game-playing, aversion to partner dependence, attention to extradyadic others, deception. Linked to greater relationship alternatives.
- They begin and maintain relationship using strategies, they don’t let relationship become too intimate to not lose control and they covertly seek out other potential romantic partners
Storge
Emphasis on companionship and trust in relationships
