Personality disorders originate in early childhood, and both the environmental and genetic backgrounds are involved in their etiopathologies. It is characterized by an enduring pattern of inner experience & attitude that deviates markedly from the expectations of people around or the related culture(1). Patients have pervasive & long-standing traits which affect their perception, cognition, emotion, and behavior, as well as their ability to function in interpersonal or other social roles.
Three Clusters Of Personality Disorders
According to the “Diagnostic & Statistical Manual of Mental Disorders” (fifth edition), personality disorders are divided into three clusters. They are
- Type A cluster includes schizoid, paranoid and schizotypal types,
- Type B cluster includes borderline, antisocial, narcissistic, histrionic, and
- Type C cluster includes dependent, avoidant, & obsessive-compulsive.
A research analysis studied by the World Health Organization (WHO) has revealed that the prevalence assessments are 6.1% for any personality disorder; and 3.6%, 1.5%, and 2.7% for type A, B, and C cluster correspondingly(2).
A narcissistic personality disorder is a distinct personality disorder, falls in type B cluster. It describes the person character who behaves as grandiosity (impressiveness in behavior or fantasy). They generally tend to recreate appreciation and sometimes they do not understand(3). Narcissistic personality disorder is estimated to affect 7.7% of males and 4.8% of females in the general population(4) and it remains one of the least studied personality disorders.
How To Diagnose Narcissistic Personality Disorder?
Narcissistic personality disorder needs to be diagnosed by a professional. Commonly, the treatment involves talk therapy i.e. scientifically it is known as “item response theory”. According to the theory of psychological measurement, item response theory is a standard form of design and investigation which involves questionnaires. The answer from the individuals helps the professionals to judge their character and attitudes(5). This design can easily predict the participant sufferings and symptoms which further makes it easier to put them at a specific degree of narcissistic personality severity(6).
Application of item response theory methods is emerging in the evaluation of DSM (Diagnostic & Statistical Manual of Mental Disorders ) criteria, including criteria for alcohol dependence, nicotine dependence, amphetamine, cocaine, and prescription drugs, unipolar and bipolar depression, mania, personality disorders, post-traumatic stress disorder, bulimia and attention-deficit/hyperactivity disorder(7).
Procedure For Evaluation Of Narcissistic Personality Disorder
The scientific team of psychiatrists interviews and evaluates the patients/participants metacognition levels. Patients/ Participants are asked to write the questionnaire which brings about their particular degree of symptoms associated suffering over the past 2 weeks. It has a scale ranging from 1 to 4, which signifies 1 as not at all and 4 as very much. The questionnaires/analysis apart from symptoms agenda, it also involves Alexithymia Scale (Toronto Alexithymia Scale -a measure of deficiency in understanding, processing, or describing emotions), structured clinical interview for personality disorder diagnosis, and Metacognition Assessment Interview. Metacognition Assessment Interview specific questions will be based upon four metacognitive sub-functions such as Monitoring, Integration, Differentiation, and Decentration(7).
The neuroimaging techniques such as computerized tomography (CT), magnetic resonance imaging (MRI), functional MRI (fMRI), single-photon emission CT (SPECT), and positron emission tomography (PET) can reveal the volumetric abnormalities in regions and their ratio to the whole brain in personality disorders. The advent of MRI has truly revolutionized the field of neuroimaging(8).
What Is The Best Medicine For Narcissistic Personality Disorder?
Till now there is no best medicine prescribed for treating narcissistic personality disorder, because narcissistic personality disorder does not respond to chemotherapy(10).
But, psychotherapist suggests drugs which involve antidepressants and antianxiety which could support the alleviation of symptoms. Talk therapy or psychotherapy i.e. consultation with a psychiatrist is the best approach for this personality disorder.
Family Therapy Or Group Therapy
Family therapy or group therapy is the best alternative for affected individuals to recover from narcissistic personality disorder. This must be kept for prolong period which would be effective for sufferers to realize their damaged lives. However, this group/family or psychotherapy must be approached with loving care and patients do not push too fast.
Cognitive Behavioral Therapy
The most vibrant therapy for narcissistic personality disorder is cognitive behavioral therapy(11). It supports to improve mental health by changing their thought and behave. It is a psycho-social intervention, thought-provoking, improves emotive, and manage the problems. Today, cognitive behavioral therapy is universally practiced by the therapist to alleviate various personality disorders such as paranoia, alcohol/substance addictions, depression, and anxiety.
Scientifically, it is called as insight-oriented therapy, which focusses on inner unconscious content of patients and eases their psychic tension (13). The main objectives of psychodynamic therapy or psychoanalytic psychotherapy for narcissistic personality disorder are to create person cognizance and realize their past and present behavior.
Schema therapy is focused on patients who are unsuccessful to respond after having been through other therapies. A schema is defined as an organized pattern of thought and behavior. This therapy is to help patients meet their basic emotional needs. It is a long-term process which requires 18-36 month of therapy and it possesses a comprehensive variety of methods, such as social interaction, psychoanalytical therapy, experiential and interpersonal strategies(12).
Skills training interventions are focused mainly on borderline personality disorder by supporting coaching, demonstrating model, and providing opportunities for practice(14). It is effective to decrease the self-damaging manners associated with a borderline personality disorder.
Challenges In Therapy
It is a difficult process for health professionals to treat narcissistic personality disorder affected individuals as they will not cooperate naturally during the early stages of the disorder. They resist the therapy and it is the psychiatrist’s duty to make the individuals co-operate for the treatment. Most of the individuals are treated by the residential mental health treatment facility which is effective for narcissism as therapy is regular and intensive(15). It is supportive for advanced disorder and helpful process to reduce the symptoms. It is most challenging as sufferers feel unstable and mood disorders are common.
Narcissistic personality disorder is a problem in which a person has an inflated sense of self-importance. Treatment can be supportive, but this condition cannot be cured completely. The disorder needs to be diagnosed by a professional clinical team of psychologists and psychiatrists based on consultation or talk therapy. Talk therapy similar to item response theory procedures is an initial stage in the assessment of DSM (Diagnostic and Statistical Manual of Mental Disorders) criteria for any psychiatric disorders.
Narcissistic personality disorder can be diagnosed by Metacognition Assessment Interview, Toronto Alexithymia Scale, and levels of a symptom of patients. The neuroimaging techniques can reveal the abnormalities in the regions of the brain in personality disorders.
There is no specific medicine for narcissism and drugs such as antidepressants and antianxiety supports the reduction of symptoms. Family therapy or group therapy, cognitive behavioral therapy, insight-oriented therapy, schema-focused therapy, and skills-based interventions therapy are the best approach for this personality disorder.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5. Washington, DC: Am Psychiatr publishing; 2013.
- DSM-IV personality disorders in the WHO World Mental Health Surveys. Br J Psychiatry. 2009 Jul; 195(1):46-53.
- Overview: narcissistic personality disorder. Akhtar S, Thomson JA Jr. Am J Psychiatry. 1982 Jan; 139(1):12-20.
- Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. Stinson FS., J Clin Psychiatry. 2008 Jul; 69(7):1033-45.
- Lord F. Applications of item response theory to practical testing problems. Hillsdale, NJ: Erlbaum; 1980.
- Hoertel N, Peyre H, Lavaud P, et al. Examining sex differences in DSM-IV-TR narcissistic personality disorder symptom expression using Item Response Theory (IRT). Psychiatry Res. 2018;260:500–507. doi:10.1016/j.psychres.2017.12.031
- Neuroimaging findings in schizotypal personality disorder: a systematic review. Fervaha G, Remington G. Prog Neuropsychopharmacol Biol Psychiatry. 2013 Jun 3; 43():96-107.
- Levy KN, Chauhan P, Clarkin JF, Wasserman RH, Reynoso JS. Narcissistic pathology: Empirical approaches. Psychiatric Annals. 2009;39:203–213.
- Matusiewicz AK, Hopwood CJ, Banducci AN, Lejuez CW. The effectiveness of cognitive behavioral therapy for personality disorders. Psychiatr Clin North Am. 2010;33(3):657–685.
- Davidson K, Norrie J, Tyrer P, et al. The effectiveness of cognitive behavior therapy for borderline personality disorder: Results from the borderline personality disorder study of cognitive therapy (BOSCOT) trial. J Personal Disord. 2006;20(5):450–465.
- McGinn LK, Young JE. Schema-focused therapy. In: Salkovskis PM, editor. Frontiers of Cognitive Therapy. The Guilford Press; New York: 1996. pp. 182–207.
- Behavior Therapy vs. Insight-Oriented Therapy for Repeated Suicide AttemptersArch Gen Psychiatry. 1981;38(10):1126-1130.
- Dialectical behavior therapy for borderline personality disorder. Lynch TR, Trost WT, Salsman N, Linehan MM Annu Rev Clin Psychol. 2007; 3():181-205.
- Co-occurrence of 12-month mood and anxiety disorders and personality disorders in the US: results from the national epidemiologic survey on alcohol and related conditions. Grant BF, Hasin DS, Stinson FS, Dawson DA, Patricia Chou S, June Ruan W, Huang B J Psychiatr Res. 2005 Jan; 39(1):1-9.