Narcissistic personality disorder, or narcissism, is one of the mental disorders associated with a particularly strong and non-adaptive personality. The narcissist appears very self-absorbed, but in fact has a very low self-esteem and is always looking for recognition.
What is narcissism?
The personality disorder was named after the legend of Narcissus, who is so in love with his reflection that he neither recognizes nor can return the love of the nymph Echo. He dies over his despair of not being able to reach his reflection. One could now assume that the narcissist is characterized by great self-absorption. However, it is not that simple, narcissistic personality disorder is a complex mental disorder with many symptoms. Affected individuals suffer from a strong inward rejection of themselves, combined with very low self-esteem. Externally, due to their constant search for admiration and recognition, this comes across as overconfidence, arrogance and as if those affected take themselves very seriously.
Causes
Narcissistic personality disorder is a complex mental disorder that is similar in large part to borderline symptomatology. However, narcissists differ from borderline sufferers in important ways. For example, they usually have very good impulse control and they do not suffer from self-destructive behaviors. However, the similarity between the two disorders is evident in their causes. Both disorders are early childhood and arise due to insufficient or excessive parental attention. These traumatic experiences are repeated in adulthood in a lack of self-confidence and excessive search for recognition with a compulsion to perform and are reproduced to the environment. It must be said, however, that affected individuals are usually unaware of their behavior and thus cannot be said to have acted intentionally on the part of the individual.
Symptoms, complaints, and signs
Narcissism is primarily manifested in a greatly increased self-esteem. The narcissist believes of himself that he is special and unique. This results in a strong fixation on himself and attempts to impress others. Lies and self-deceptions are often part of the image that the narcissist tries to maintain of himself. Social skills are lost in the process. Thus, people with narcissistic personality disorder are less capable of empathy. In interpersonal relationships, they are not at all or hardly able to reciprocate emotions. Therefore, narcissists often appear cold and arrogant to those around them. The urge to be important can manifest itself in two forms: Thus, the narcissist can either constantly flaunt his (supposed) skills or be very modest. At the same time, narcissistic people often have dreams and fantasies about money and status. Their behavior is designed accordingly. The expectation of other people is based on the idea that they are there to fulfill the needs of the narcissist. Accordingly, narcissists take advantage of other people. They sometimes react viciously when their expectations are not met. Angry outbursts and revenge occur. Accordingly, narcissists are easily angered. Narcissists are also prone to envy and also believe that others are envious of them.
Diagnosis and course
Diagnosis of narcissistic personality disorder follows the survey pattern for all mental disorders and takes place in the outpatient clinic of a psychiatric hospital. Self-tests can be found on the Internet, but their validity may be doubted, especially since these tests can cover only a few facets of behavior and only a few symptoms. The detailed diagnosis of a personality disorder usually takes several hours and includes personal interviews with a therapist as well as the completion of numerous questionnaires. This precise diagnosis is important in order to be able to make a specific diagnosis, to identify the individually strong symptoms and thus the exact disorder pattern. Only then can an individual therapy be initiated. Like all severe personality disorders, narcissism cannot be completely treated, but the person affected can be helped to lead a symptom-free life.
Complications
Narcissistic personalities make high demands on themselves and their environment. Their grandiose appearance and strong sensitivity to criticism make dealing with other people difficult. In particular, sufferers with the grandiose manifestation of narcissism often tick off or become angry when they do not receive the confirmation and recognition they crave from those around them. Although there is a desire to belong, lack of empathy causes recurrent social conflicts. As a result, narcissists experience rejection from their peers and become isolated. Those with vulnerable narcissism, on the other hand, are often overadjusted and suffer from a lack of self-worth. They also find interacting with others challenging due to social anxiety and fear of rejection. They tend to exhibit avoidant behavior. As a result of the social difficulties that arise due to this personality structure, affected individuals may develop depression or anxiety disorders. Not infrequently, they also tend toward addictive behavior. Depth psychology-based psychotherapy and psychoanalysis help those affected to cope better with their specific problems. The goal is to stabilize self-esteem. However, the behavioral patterns are profound and difficult to treat. Even in therapy, conflicts can arise due to experiences of grievance.
When should you see a doctor?
The problem with narcissism is that the sufferer has no insight into his narcissistic personality structure. He therefore does not consider it to be in need of treatment. His fellow world often suffers considerably from the behavior of the narcissist. It is therefore not uncommon for victims of narcissists to seek treatment. A narcissistic personality disorder is considered untreatable. It is true that the suffering of a narcissist can be high. But most of the time he will still not see a therapist. Other people do not dare to suggest therapy to him. They would have to reckon with corresponding reactions. One of the characteristics of a narcissist is his complete lack of insight, coupled with an unwillingness to change.
Treatment and therapy
Treatment of narcissistic personality disorder involves psychotherapeutic measures and, depending on the severity and expression of symptoms, psychotropic drugs. Therapy of concomitant symptoms and problems is also important. For those affected by narcissistic personality disorder, these are primarily depression and drug abuse. As a rule, the patient can determine which form of therapy suits him best: inpatient or outpatient. Depth psychological, psychoanalytical or behavioristic. However, a major role in finding the appropriate therapy is played by the diagnosis and the assessment of the need for therapy made there. If it is determined that the patient requires several weeks of inpatient therapy due to the severity of his or her symptoms, outpatient measures are usually not effective. An additional complicating factor in the search for a therapist is that many psychologists feel overburdened with severe personality disorders and do not include affected persons in their patient files, so that they actually have much less leeway in choosing the appropriate therapy than would theoretically be possible. In order to be able to initiate successful therapy, the affected person must exhibit a pronounced pressure of suffering that motivates him or her to cooperate. Coercive therapy or psychological intervention against the patient’s will or in the case of insufficient motivation are not promising and, in this respect, are not carried out.
Prospect and prognosis
Prognosis varies widely for people with narcissistic personality disorder. Thus, overall, people in therapy have a better prognosis. The ability to learn proper self-awareness is crucial. Furthermore, stable interpersonal relationships that allow a high degree of trust and reflection to develop, as well as personal experiences of success that result from one’s own skills, are also considered helpful. These factors have a favorable effect on narcissism, since they keep the person concerned well aware of his abilities and confront him with the consequences of his actions. Inaccessible narcissists have a much worse prognosis. This is especially true for people who experience many failures and are not accessible to therapy, aggravated in these cases often alcohol and other drugs.Accordingly, narcissism in the sense of a perceived high self-esteem is indeed experienced. But reality does not match this self-image. In the case of narcissists, there is also the danger that a severe failure frustrates them so much that they experience depressive episodes. On the other hand, these personal breakdowns are often cited by patients as a reason for seeing a therapist.
Prevention
Narcissistic personality disorder cannot be prevented on its own. Parental love and attention and timely intervention, if necessary, are the most important keys to prevention.
Aftercare
People who have narcissistic personality disorder often have to work on themselves throughout their lives to navigate the tightrope between normal and exaggerated narcissism. A high degree of willingness on the part of the patient to actively participate in treatment and aftercare often has a positive influence on further personal development. Therapists often work out strategies for aftercare with their patients in the final phase of psychotherapy. This often involves how those affected can maintain the success of the therapy. After inpatient therapy, clinics offer special programs to support their patients in the period after discharge. These are usually outpatient services designed to ease the transition from the clinic to everyday life. Within this framework, various therapeutic approaches can be applied, for example discussion groups, psychoeducation programs or individual discussions with a psychiatrist or psychotherapist. Aftercare may also include support or accompaniment by a social worker. Narcissistic personality disorder is not equally severe in every patient. Therefore, aftercare can also vary in intensity, for example by adjusting the frequency of discussions.
Here’s what you can do yourself
Narcissists often have problems empathically empathizing with others. Therefore, it can be helpful if they consciously address the issue of empathy. For example, if a person reacts differently than expected, they can pause and consider how the situation went from the other person’s perspective. Often, people feel blindsided by narcissists because they perceived a situation completely differently. The narcissist’s lack of understanding often makes it even more difficult for them or evokes anger. Narcissists often have to learn to recognize such dismissive and hurt reactions from friends, acquaintances, and family members as legitimate. Some narcissists tend to manipulate other people. The influence need not be malicious by any means – it typically has the goal of pleasing others and making oneself the center of attention. A frequently used means is to make other people dependent on oneself. If a narcissist is prone to such behaviors, he should become aware of his own patterns. He can then consider why he behaves in a certain way and whether the intention is appropriate. Self-help groups can help support this reflection. The Internet offers the possibility of anonymously asking for opinions – for example, on typical situations in which the affected person cannot put himself in other people’s shoes.
