Mental health articles

narcissistic personality disorder case study Narcissistic personality disorder (NPD) is
characterized by a “pervasive pattern of grandiosity, need for admiration, and
lack of empathy that begins in early adulthood” (American Psychiatric Association,
2000, p. 714). Oft en viewed as the most obnoxious of the personality
disorders, NPD individuals not only are arrogant but also have disdain for
others and expect to be catered to (Millon et al., 2000). Typically the primary
diagnosis of NPD has a prevalence in a clinical setting of only from 2% to 16%
and of less than 1% to 5% in the general population; however, NPD accounts
for up to 21% of clients receiving personality disorder diagnoses (Gunderson,
Ronningstam, & Smith, 1995).
Oft en narcissistic disturbances occur in the late teen years and early twenties,
presumably due to developmental challenges at this time. Self-absorption
at this developmental point is not unusual, but these individuals have a pathological
level of self-importance, with dramatic variations from strong feelings
of entitlement and rage to shame and envy. Th ey lack sustained commitment
to others and oft en exploit others to serve their own self-esteem (Ronningstam,2005). Th ese persons oft en come to treatment in the midst of a career crisis or
following an ultimatum from a signifi cant other.

Bart is a very attractive, intelligent third-year medical student from a
successful family of physicians. Within the fi rst 10 minutes, he informs
the therapist that his parents are “best friends” with the president of the
university and that a bust of his grandfather sits in the medical school
library. He asks the therapist about her degree and laughs when she
reports that she is a licensed psychologist: “What, med school too hard
for you?” He identifi es medical school as easy for him, notes his very
high IQ, says that while other students need to do clinical rotations it’s a
waste of time for him, and says that the medical school should be thankful
he chose to train there. Th e dean of the medical school, he reports,
is “an idiot” for recommending that Bart come to counseling because of
poor relationships with faculty and students. He does admit that he can
be boastful and arrogant but insists that he has reason to be.

Kohut (1977) conceptualizes narcissism as a developmental arrest requiring
the therapist to provide accurate empathy and appropriate mirroring, which
helps the student move beyond the needs of the grandiose self. Typically students
with NPD require long-term treatment, but getting them to accept this
is diffi cult. Linking the NPD student with an outside provider identifi ed as an
expert appeals to their narcissism and may make the transition easier.
Aims of treatment with Bart were to decrease his sense of entitlement and
increase his awareness of his impact on others. Another focus was to increase
his awareness of life’s inevitable disappointments and his responses to them.
Bart may have been unconsciously wounded that he was not accepted in the
medical school where his family members were prominent. From a cognitive
perspective, it was important to challenge Bart’s perception that his family
was disappointed in him and to alter his aff ective reaction to this disappointment.
By reviewing his life goals and aspirations, Bart recognized that doing
well at this medical school would help him reach his career dream.

Tags: disorder, Personality Disorder