Session 11B: Narcissistic Personality Disorder (NPD)

Essential Feature:
Pervasive pattern of G, need for
A and lack of E

grandiosity, admiration, empathy

Prominent features:

D,
A
inclined to feel M
hypersensitive to C
ideas of P
S-R
C of others

dominant, arrogant, mistreated, criticism, perfection, self-righteous, contemptuous

Self Image
Presumed S with underlying F self-esteem

superiority, fragile

View of Others
Valued for what they can P and Exist to
attend to N of individual with NPD

provide, needs

Relationships
Expect enormous effort & S with no
R (unilateral)

sacrifices, reciprocity

Issues with Authority
Often A authority
Non-deferential, C with others

ARE, condescending

BEHAVIOR
A
haughty
A
social P
A
emotionally, verbally A
Cold S; promiscuity

arrogant, assured, poise, abrasive, abusive, seductiveness

Affect
feigned T
I, depressed
R, indignation, fear
Sudden, unexpected V in response to
humiliation or derogation

tranquility, Irritable, Rage, violence

DEFENSES

Self-D (preferred reality =Reality)
R
F/imagination
R

deception, Rationalization, Fantasy, Repression

ALTERNATE REALITY
Lack solid contact with R
“Others are L to be near me”
“I am S, talented, beautiful & intelligent”
“I was meant to be G”
“should have it allI should have it all”

reality, lucky, special, great

PROTECTIVE FACTORS

personal S & aversion to W
Strong desire to be seen as strong, C & successful

strength, weakness, capable 

RISK FACTORS

Attraction to feeling of D & well-being
Relief of D
Attraction to skills and challenges of drug D world
R prone yet so S sensitive returning to T after = U
need for high level of S
Propensity for P pattern (alcohol, mj, heroin

dominance, discomfort, dealing, Relapse, shame, treatment, unlikely, stimulation, polydrug

Drugs of Choice

C & M
(stimulate feelings of P, vigor,
E, etc)
A & other S- hypnotics (to
ward off intrusve unpleasant R)
P

Cocaine, meth, power, euphoria, Alcohol, sedative, reality, Psychedelics

TREATMENT RECOMMENDATIONS

Joining; sustained E
Be aware of core need for self-A
and subsequent I on treatment
A & engagement
T & caution; F is REAL
S-E preserving interventions
Confrontations embedded in strong S
 Model admitting and tolerating one’s own
F/M
Follow rules, maintain B
Assess for D and S
C Treatment; ?/?

empathy, aggrandizement, implications, acceptance, Tact, frailty, Self-esteem, support, faults, mistakes, boundaries, depression, suicidality, Cognitive, AA, NA

THINGS TO AVOID TREATMENT:

-unchecked feelings of B, impatience,
irritation, indignation or feeling
dismissed/invisible (C)
-Pull to feeling “S” by association
-Accept undue B or responsibility for the
sake of the therapeutic A
-C critcism

boredom, countertransference, special, blame, alliance,  Constructive

Countertransference Issues in Treatment of Narcissistic PD (Goldberg)

NPD patients expect therapists to be part of S (self O) to perform F to heal internal D, therapist may feel U,
mirror transference: therapist wishes for same (validation and A), may enjoy feeling I by patient 

self, object, function, deficit, used, admiration, idealized