Is Narcissism an Illness?
Narcissism is a natural feature of the human condition. Many teens have an abundance of it and so do many adults. So, at what point does it become abnormal and need treatment? The question to have exercised many eminent minds over the years is whether a person with narcissistic personality disorder is actually ill? Is a so-called personality disorder little more than an exaggeration of normal personality? Its extreme nature may well make people feel uncomfortable, but this doesn’t mean the person is ill. Or, is a personality disorder a symptom-based illness that manifests as an extreme of personality? If this is the case then treatment is called for.
The Rationale for Therapy for Narcissistic Personality Disorder
Removing the rug from beneath the feet of a person with narcissistic personality disorder can result in a perception that their world is collapsing. Personal illness, being given the sack, or being repeatedly denied promotion, are examples. Providing therapy for narcissistic personality disorder is no easy matter. People with the disorder already feel different and isolated yet few will admit to having problems and may only attend therapy if absolutely necessary. They will typically demand to see the top specialist in the field and, if referred for psychotherapy, will often regard the therapist with contempt. This alone sets the scene for a difficult relationship with a high risk of drop-out.
There is an extreme lack of awareness in the individual with narcissistic personality disorder. The need for self-aggrandizement, sense of personal entitlement, superiority, desire for respect and use of complex defense mechanisms, all provide the infrastructure to maintain their sense of self. If the person does raise issues relating to interpersonal problems the therapist is provided with a tentative opportunity. Rather than attempt to challenge the person about aspects of their personality, which are likely to be disregarded, the therapist is more likely to suggest adaptive techniques to enable, for example, easier relationships. The goals are nearly always modest and are tempered by the reality that the person lacks empathy and tends to devalue those around them.
The basic aim of cognitive therapy for narcissistic personality disorder is to assist in identifying unhelpful and unconstructive thoughts and replacing these with more adaptive thoughts. In turn, this helps the person to better control how they respond to a variety of situations and circumstances they, or others, experience difficulties with.
Cognitive therapy may have an edge over individual psychotherapy. This may partly be due to the fact that disclosure of personal shortcomings is not a requirement, but also the approach is also more technique driven. With careful management the therapist may be able to appeal to the exploitative and self-interested aspects of personality by suggesting gains could be obtained, for example, by being more polite to employees.
Success depends largely on the degree of narcissism. In milder cases it is possible to see significant improvements in sensitivity, empathy and reductions in black-and-white thinking.
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Young, J.Q., Narcissistic Personality Disorder. In: Ferri, F.F., ed. Ferri's Clinical Advisor 2008: Instant Diagnosis and Treatment. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008.