L4-CCP-Narcism

History on narcism

• young construct, originated from narcissus in greek myth

• 19/20th century; sexual interest disorder

• mid 20th century; narcissism on dysregulation of self-worth

• Since 1970s; diagnosable personality disorder

Dimensional approach narcissism

reflects AMPD that people fall along a dimension for a grandiose sense of self, with others scoring higher compared to the norm, but not immediately worrying. Extreme outliers do exist.

How can we distinguish between different levels?

By comparing person to the core aspects of normal and pathological narcissism.

a) Quality, coherence and stability of self-image

b) Affect regulation (~ regulation of self-esteem)

c) Psychological and emotional investment in others + nature and quality

of interactions

Healthy narcissism

Can be healthy in case of self preservation, imrpves self-esteem and affect regulation in moderate degrees, may also play a role in healthy interpersonal relationship to have a degree of healhty self-esteem and self-interest.

Exaggerated or high-normal narcissism

Exaggerated self-interest, risk-taking; focus on ideals and achievements. Still related to real capacities and therefore somewhat justified

b) Affect and self-esteem are usually regulated

c) Acceptable interpersonal relationships

Pathological narcissism

a) Poor regulation of self-esteem

b) Poor affect regulation (especially anger, shame, envy)

c) Dysfunctional interpersonal relationships

Narcissistic personality disorder NPD

Persistent and pervasive dysfunction (meets DSM criteria)

a) Self-esteem inconsistent, fragile, and maintained by pathological defensive mechanisms

b) Affect regulation influenced by anger, shame, envy

c) Dysfunctional interpersonal relationships

Grandiose exhibitionist or overt narcissist

• Conveyed sense of superiority

• Grand fantasies to protect self-esteem

• Use others to support and/or increase self-esteem

Vulnerable/sensitive or covert narcissist

• Inhibited, ashamed, hateful

• (Danger of) shame stands in the way of public propagation, superiority,

but also actual opportunities and possibilities

• Reluctant to engage in intimacy for fear of criticism and rejection

Catergorical classification of narcissism

A pervasive pattern of grandiosity, need fro admiration, nad lack of empahty, starts at early adulthood, must include at least 5 or mor of the following symptoms;

1) sense of self importance, 2) preoccupied with fantasies of unlimited success, power, beauty, etc 3) believes that he or she is special 4) exessive admiration 5)entitlement 6) tak eadvatange of others, 7) lack empathy, 8) envious 9) arrogant

Dimensional approach to NPD

A) Moderate to great impairment in personality functioning by two of the following 4; indentity (execessive self esteem regulation), self-direction (approval of others, unreasonable standards, entitlement), empathy (inability to empathisze with others feelings or needs), an dintimacy (superficial relations)

B) Both personality traits of grandiosity and attention seeking.

Comorbities Narcissism

Major Depressive Disorders, Substance Abuse, Bipolar Disorder, Borderline dosrder, ASPD (problematic), obsessive-compulsive, avoidant personality disorder.

Prevalence Narcissism

6.2% estimated in the general population, in clinical settings up to 22%. Unclear in forensic settings due to overlap in psychopathic traits.

Empathy

Has to do with being able to understand the feelings and thoughts of another person. Includes emotional and cognitive empathy.

Empathy and Narcissism

Traditionally thought that people with pathological narcissism cannot feel empathy (lack of capacity), however, research now find neurological deficits in systems associated with emotional empathy but also motivational and self-rehulating fluctuations for cognitive empathy. Reasons for these fluctuations may be unwillingness to engage in other’s emotions or being overwhelmed by them

Consequences fluctuations of NPD

• Positive events: temporary boost to self-image and reduction of pathological functioning (especially in the relational domain).

• Negative events: temporary deterioration of pathological functioning as a result of (the perception) of being undermined (ego threat). This may induce feelings of anger, hostility, shame, fear, irritability and depression

Reactions to negative events NPD

Anger and aggression are seen as effective ways to regulate self-worth and interpersonal functioning. Paradoxically, there is also an increased risk of self-aggression/suicide. The link between negative achievement events and self-esteem was much stronger in people with high levels of Narcissism compared to people with low Narcissism.

White collar crime (NPD)

Non-aggressive crime, such as fraud. Perpetrators are usually in positions of power, commit crime out of personal interest or protect company, exaggerated self-confidence, highly irresponsible, unreliable, take risks. Links to narcissism; fantasies of harmlessness and sucess to abuse power, lack of feeling guilt.

Domestic or intimate partner violence (NPD)

Use of physical and/or sexual aggression within romantic relationships (may also include emotional and verbal aggression). Especially narcissistic women show partner violence. Individuals with pathological narcissism often interpret ambivalent communication as personal attack, are sensitive to criticism, have a sense of entitlement and envy.

Physical aggression and NPD

• As previously mentioned: ego threat as trigger for physical violence, among other things

• Pathological narcissism important predictor of violence in clinical, forensic, and student populations

Sexual violence for NPD

Strong link between pathological narcissism and sexual aggression and coercion, possibly due to; One’s own attractiveness is not questioned (superiority), inability to take other perspective, wainting to gain status with sexual prowess, entitled to sex, punish others with sex is denied.

Assessment of pathological narcissism or NPD

• Interview, but must be careful not to cause provocations. Problems with honesty and self-understanding

• Questionnaires, but not many good ones. Self-report but lack of honesty plays a role. A lot of overlap with dark constructs.

SCID-5 PD

Standardized interview to facilitate the diagnosis of PDs according to DSM-5. Series of questions aimed at determining whether individual meets diagnostic criteria. Example: “You said that you think a lot about power, tell me more about this?”

Treatment of NPD

Individuals with pathological narcissism often unwilling to receive treatment. They often have their own agenda and will give partial truths. Be flexible, try to motivate the patient.