Fast Five Quiz: Personality Disorders

Stephen Soreff, MD

Disclosures

January 09, 2019

Besides individual psychoanalytic psychotherapy, group therapy and cognitive-behavioral therapy have also been used to treat NPD. Group therapy was initially thought to be unsuitable for patients with narcissism because clinicians assumed that these patients would be unable to handle the requisite give-and-take inherent in the group process. This initial assumption about the unsuitability of group therapy was reasonable, in that group processes usually require empathy, patience, and the ability to relate and connect to others—traits are deficient in narcissistic individuals.

Nevertheless, studies have suggested that long-term group therapy can benefit patients with narcissism by providing them with a safe haven in which they can explore boundaries, receive and accept feedback, develop trust, and increase self-awareness. The key point here is that the group therapy is long-term. The time allows the patient to feel safe in and with the group.

A concern with such therapy is that patients may become aware of their feelings of depression, sadness, and sense of inferiority. These feelings can be painful and lead to increased risk for suicide.

NPD is not associated with any specific defining physical characteristics; however, physical consequences of substance abuse, with which NPD is often associated, may also be apparent on examination. Mental status examination may reveal depressed mood. Patients in the throes of narcissistic grandiosity may display signs of hypomania or mania.

To be diagnosed with NPD, a patient must demonstrate a consistent and long-standing pattern of maladaptive behavior, starting in adolescence or early adulthood, that exemplifies five or more of the nine criteria listed in the DSM-5. According to the DSM-5, NPD is defined as comprising a pervasive pattern of grandiosity (in fantasy or behavior), a constant need for admiration, and a lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by the presence of at least five of the following nine criteria:

  • A grandiose sense of self-importance

  • A preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love

  • A belief that he or she is special and unique and can only be understood by, or should associate with, other special or high-status people or institutions

  • A need for excessive admiration

  • A sense of entitlement

  • Interpersonally exploitive behavior

  • A lack of empathy

  • Envy of others or a belief that others are envious of him or her

  • A demonstration of arrogant and haughty behaviors or attitudes

Psychotropic medications are not specifically used to treat NPD but are often used to treat concomitant anxiety, depression, impulsivity, or other mood disturbances.

For more on NPD, read here.

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