Theories to explain narcissistic personality disorder

Theories to explain narcissistic personality disorder Theories are explanations of cause-effect relationship of human phenomenon. A well-developed theory presents a set of testable propositions stating the relationships of variables producing a phenomenon i.e. it should be capable of explaining the dynamics of human behaviour. All theories of human behaviour are not alike. They do not enjoy equal status both in dimensions and depth. Some are major theories, others are mini theories, and still others are simply concepts. For example, psychoanalytic theory and reinforcement theory are major theories; cognitive dissonance theory and attribution theory are mini theories; and complementary theory of attraction and narcissistic theory of personality disorder are simply concepts. We take up Freudian psychoanalytic theory first. Freuds (1910, 1911) first explicit formulation of narcissism conceived it is a normal phase of development standing midway between autoeroticism and object love. During this transitory period, initially diverse and unconnected autoerotic sensations were fused into what was experienced as ones body, which then become a single, unified love-object. In 1914 Freud aligned narcissism with libido theory and proposed that it ultimately matured and diffused into object relationships. Shortly thereafter he reformulated his thinking on the developmental sequence and spoke of the autoerotic phase as the primary narcissistic condition. This first phase became the initial repository of libido from which emerged not only the love of self but love in general. In time narcissism was conceived by Freud as a universal developmental process that continued through life but unfolded through se ­quential stages. He recognized that difficulties may arise in this normal, sequential progression. First, the re may be failures to advance from li ­bidinal self-love to object-love, and, second, pe ­culiarities may occur in the way the person expresses narcissistic love. Freud (l914/ I925) described this latter difficulty as follows: We have found, especially in persons whose libidinal development has suffered some disturbance, as in perverts and homosexuals that in their choice of love-object they have taken as their model not the mother; but their own selves. They are plainly seek ­ing themselves as love object and their type of object choice may be termed narcissistic. (p. 45) In this only major paper devoted exclusively to narcissism, Freud (1914) suggested that in certain casesnotably among perverts and ho ­mosexuals libidinal self-centeredness stems from the childs feeling that caretakers cannot be depended on to provide love reliably. Either re ­buffed by their parents or subjected to fickle and erratic attention (seductive one moment and dep ­recating the next) these children give up as far as trusting and investing in others as love-objects. Rather than rely on the capriciousness of others or risk their rejection, these youngsters avoid the lasting attachment they achingly desire and de ­cide instead that it is only themselves they can trust and therefore love. In light of current debates within psychoana ­lytic circles, it is important to note that the devel ­opmental origin of the term narcissism described here was only one of several concepts that Freud posited as the source of libidinal self-cathexis. Moreover, the paper was not written for the purpose of formulating either a narcissistic personal ­ity type or a narcissistic character structure. Rather, Freuds interest lay in exploring and elaborating variations in both the development and the nature of libidinal cathexis. As far as clinical syn ­dromes were concerned, he referred in this paper to characteristics observed among paraphrenics (paranoid schizophrenics), megalomaniacs, and hypochondriacs. When Freud wrote, for the first time in 1931, about narcissistic libidinal type, he de ­scribed this individual as follows: The main interest is focused on self-preservation; the type is independent and not easily overawed, à ¢Ã¢â€š ¬Ã‚ ¦People of this type impress others, being personalities; it is on them that their fellow men are specially likely to lean; they readily as ­sume the role of leader, give a fresh stimulus to cultural development or break down existing con ­ditions. (p. 249) What is striking in this quote is Freuds charac ­terization of the narcissists strength and confi ­dence, especially since it contrasts so markedly with the low self-esteem, feelings of emptiness, pain, and depression that certain of his recent disci ­ples (Forman, 1975; Kohut, 1971) attribute to this personality, Disparities in characterizations such as these often arise as a consequence of shifts in Freuds formulations from one period to another: over his productive and long career. In this case, it can be traced to the fact that Freud identified sev ­eral origins of narcissistic self-cathexis, only one of which is the type of parental caprice and rejec ­tion that may lead to feelings of emptiness and low self-esteem. As evident from earlier excerpts, and as later elaborated further, Freuds description of the narcissistic libidinal type, brief though it is, corresponds much more closely to the DSM-III portrayal of the narcissistic personality than do several contemporary characterizations that trace their antecedents to either parental rebuff or unreliability. Relevant to this issue is a Freuds view that that narcissistic self-investment is more likely to be a prod ­uct of parental overvaluation than of parental devaluation. Moving back somewhat to the 1920s, we find three analytically oriented theorists who addressed the concept of a narcissistic personality. Wilhelm Reich claimed to have first formulated what he termed the phallic-narcissistic character at a Vienna Psychoanalytic Society meeting in 1926, although Waelder (1925) made reference to narcis ­sistic personality features in an earlier paper focusing on the mechanisms of the psychotic process. According to Kernberg (1967) narcissists present an unusual degree of self-ref ­erence in their interactions with other people, a great need to be loved and admired by others and a curious apparent contradiction between a very in ­flated concept of themselves and an inordinate need for tribute from others. Their emotional life is shallow. They experience little empathy for the feelings of others, they obtain very little enjoyment from life other than from the tributes they receive from others or from their own grandiose fantasies, and they feel restless and bored when external glit ­ter wears off and no new sources feed their self  ­regard. They envy others, tend to idealize some people from whom they expect narcissistic supplies, and to depreciate and treat with contempt those from whom they do not expect anything (often their former idols). In general, their relationships with other people are clearly exploitative and sometimes parasitic. It is as if they feel they have the right to control and possess others and to exploit them with ­out guilt feelings, and behind a surface which very often is charming and engaging, one senses coldness and ruthlessness. Very often such patients are considered to be dependent because they need so much tribute and adoration from others, but on a deeper level they are completely unable really to de ­pend on anybody because of their deep distrust and depreciation of other. (p. 655) Kernberg (1967) asserted that the haughty and grandiose constellation of behaviors that charac ­terizes the narcissist is a defense against the pro ­jection of oral rage that, in turn, stems from the narcissists incapacity to depend on inter ­nalized good objects. In this etiologic formula ­tion, Kernberg claimed that the experiential background of most narcissists includes chroni ­cally cold parental figures who exhibit either in ­difference or covert, but spitefully aggressive, attitudes toward their children. At the same time, the young, future narcissist is often found to pos ­sess some special talent or status within the fam ­ily, such as playing the role of genius or being the only child. This quality of specialness serves as a refuge, at first only temporarily but ultimately an often-returned-to haven that reli ­ably offsets the underlying feeling of having been unloved by the vengefully rejecting parent. Kernberg (1975) describes the following pointwise eleven characteristics of narcissistic personality: Excessive self absorption. Superficially smooth, appropriate and effective social adaptation covering profound distortions in internal relations with other people. Intense ambitiousness. Grandiose fantasies existing side by side with feelings of inferiority. Over dependence on external admiration and acclaim. Feelings of boredom and emptiness. Endless search for gratification of strivings for brilliance, wealth, power and beauty. Incapacity to love to be concerned or to be empathic toward others. Chronic uncertainty and dissatisfaction about oneself. Exploitativeness and ruthlessness toward others. Chronic, intense envy, and defenses against such envy e.g., devaluation, omnipotent central and narcissistic withdrawal. Kohuts Approach Kohuts (1971) views are more difficult to summa ­rize than those of Kernberg, perhaps as a conse ­quence of their greater originality. Despite having been written in esoteric, if not obscure, psychoanalytic jargon and having been formulated in an ingenious, if at times ponderous and tautological fashion, Kohuts work has attracted numerous disciples. Fortunately, a score of in ­terpreters have sought to elucidate his metapsy ­chological assertions, which many consider among the more imaginative advances in recent analytic theory (Forman, 1975; Gedo Gold ­berg, 1973; Palombo, 1976; Wolf, 1976). Kohut (1971) rejects the traditional Freudian and Kernbergian thesis that narcissistic self-investment re ­sults from a defensive withdrawal of object-love attachments following a pattern of chronic parental coldness or vengeful spite. This classical view con ­tends that narcissism is a result of developmental arrests or regressions to earlier points of fixation. Thus, the future narcissist, according to standard analytic metapsychology, regresses to or fails to progress through the usual developmental sequence of initial undifferentiated libido, followed by auto ­eroticism, narcissism, and, finally, object-love. It is not the content as such but the sequence of libidinal maturation that Kohut challenges. His clinical ob ­servations have led him to assert that the primitive narcissistic libido has its own developmental line and sequence of continuity into adulthood. That is, it does not fade away by becoming transformed into object-libido, as contended by classical theo ­ri sts, but unfolds into its own set of mature narcis ­sistic processes and structures. In healthy form, for example, these processes might include behaviors such as humor and creativity; similarly, and most significantly, it is through this narcissistic develop ­mental sequence that the cohesive psychic structure of self ultimately emerges. Pathology in narcissistic development, according to Kohut, occurs as a consequence of failures to in ­tegrate one of two major spheres of self-maturation, the grandiose self and the idealized parental image. Confronted by realistic shortcomings that undermine early feelings of grandiose omnipotence, or subsequently recognizing the equally illusory na ­ture of the idealized powers they have attributed to their parents, these children must find a way to overcome their disappointments so as not to fragment If disillusioned, rejected, or experienc ­ing cold and unempathic care at the earliest stages of self-development, serious pathology, such as psy ­chotic or borderline states, will occur. Trauma or disappointment at a later phase will have somewhat different repercussions depending on whether the difficulty centered on the development of the grandiose self or on the parental imago. In the for ­mer, the child will fail to develop the sense of ful ­fillment and self-confiden ce that comes from I feeling worthwhile and valued; as a consequence, these needs will split off and result in the persis ­tent seeking of narcissistic recognition through adulthood. Along the second line of self-develop ­ment, children who are unable to idealize their par ­ents because of the latters indifference or rejection will feel devastated, depressed, and empty. Through adulthood, they will seek idealized parental surro ­gates who, inevitably, will fail to live up to the om ­nipotent powers the narcissists hoped to find within them. In their desperate search for an ideal that is greater than themselves, they are often led to be ­ have in a weak and self-effacing manner that will enable others to overshadow them. What is notable is that Kohuts is a developmen ­tal theory of self and not a personality characterization. Nevertheless, it leads to a clinical picture that at variance with those of Freud, Kernberg, and the DSM..III and IV. The features that emerge from Kohuts descriptions have been summarized by Forman (1975). Listed among the more promi ­nent are (a) low self-esteem, (b) tendencies toward periodic hypochondriasis, and (c) feelings of emptiness or deadness. Bursten (1973) has sought to distinguish four personality variants within the narcissistic grouping, speaking of them as the craving, paranoid, ma ­nipulative, and phallic types, He refers to the craving variety as clinging, demanding, often pouting and whining (p. 290). Those labelled paranoid narcissists correspond with general descrip ­tions of the paranoid personality. Manipulative narcissists encompass a large segment of what are referred to as antisocial personalities in the DSM-II. The fourth subtype, phallic narcissists, describes patients who are exhibitionistic, reckless, cold, and arrogant. In seeking to contrast borderline from narcissistic personalities, Bursten makes reference to the distinction as bearing on the cohesiveness of self. Elaborating this distinction, he speaks of the narcissistic personality as comprisingà ¢Ã¢â€š ¬Ã‚ ¦a group of people whose sense of self is suffi ­ciently cohesive that they do not suffer from these types of fragility problems, The striking feature of this cluster of personality types centers around self-esteem, They maintain an intense interest in themselves and harbor both grandiose fantasies, al ­beit not to a delusional extent, and the need to as ­sociate with powerful figures, When one frustrates their vanity or their need for an ideal parent, they become dysfunctional-they suffer severe dis ­appointment, depression, rage, and hypochondria ­sis, They may even have fleeting episodes of confusion, but such mental disintegration is very brief and does not have the prominence and the persistence of people whose personalities fall in the borderline cluster. To be noted, cohesiveness of their sense of self is maintained by the intensity focus on themselves. (Bursten 1973, p. 414). Drawing on Burstens conceptions of self ­ cohesiveness, Adler (1981) elaborates further on the continuum of narcissistic and borderline personalities: Borderline patients have serious difficulties in maintaining stable self-object transferences as well as a sense of self-cohesivenessà ¢Ã¢â€š ¬Ã‚ ¦ Patients with narcissistic personality disorders on the upper end of the continuum are able to main ­tain self-cohesiveness, except for transient fragmentation. These fragmentation experiences can often be examined in the therapeutic situation with ­out serious disruptionà ¢Ã¢â€š ¬Ã‚ ¦ Finally, patients with a narcissistic personality disorder do not experience the feelings of aloneness experienced by borderline patients. From the borderline patient capable of a serious regression at one end of the continuum to the patient with a stable narcissistic personality disorder at the other end, we can evaluate our patients, using cohesiveness of the self; self-object transference stability, and the achievement of aloneness. (pp. 47-48) Coopers Approach Cooper (1984, 1988, 1989) has written exten ­sively on different facets of the narcissistic char ­acter, describing aspects of its development, the central role of an integrated self-image, and its in ­tertwining with masochistic like tendencies. In each sphere, his Insights have been unusually as ­tute and his themes both scholarly and eloquently expressed. Speaking of the importance of an integrated self-image, Cooper (1984) writes: A vital aspect of normal self-development is the achievement of an internalized, integrated self image (p.46) Different workers have referred to these integrative capacities and failures .in a variety of ways Kohut spoke of enfeebled selves lacking co ­hesion, Kernberg speaks of splits in self-represen ­tations. Erikson referred to identity diffusion, and winnicott spoke of the false Self. Under many different headings, every investigator in this area has emphasized the core importance of the cre ­ation of a unified, coherent, integrated i nner sense of self. (p. 47) Describing the intermeshing of narcissistic and masochistic pathology, Cooper (1989) comments: Frustrations of narcissistic strivings lead to repara ­tive attempts to maintain omnipotent fantasiesà ¢Ã¢â€š ¬Ã‚ ¦.Self esteem takes on a pathological quality when an individual begins to derive satisfaction from mas ­tery of his own humiliations. A pattern of deriv ­ing pleasure out of displeasure has begun. This pattern provides the groundwork for the later clini ­cal picture of . . . the injustice collector. These individuals are basically narcissistic- ­masochistic characters and their analysis regularly reveals that narcissistic defenses of grandiosity and entitlement are used to ward off masochistic tenden ­cies toward self-abasement and self-damage. (p. 314) Taking issue with the descriptively narrow for ­mulations of the narcissistic personality in the DSM, Cooper and Sacks (1991) offer the following comments: The diagnostic features are a caricature not a clinical picture. The core issue is a conflict over self-esteem in defense of self-inflation. This grandiosity is more or less fragile or becomes more or less pathologically unrealistic when threats to self-esteem and self-representation .are present in the form of criticism tasks beyond ones capacity, etc. These patients often have a slippery ethical sys ­tem, not out of intent to exploit, but out of the need to hide flaws and keep their defects secret. Narcissistic characters also have frequent paranoid tendencies, again arising out of the need to hide im ­perfections. The sense of needing to feel perfect is as much a part of the picture as grandiosity, which is an overt characteristic. (p.3) Akhtar and Thomsans Approach In a series of particularly insightful papers, Akhtar and Thomson (1982) have sought to bring the scattered literature on the narcissi into a multifaceted profile, including their characteristic overt and covert features in six areas of psychoso ­cial functioning. In a recent book, Akhtar (1992) indicates that narcissists appear overtly grandiose, exploitative, seductive and articulate. Covertly, however, they are doubt-ridden, envious of others; chronically bored corruptible, and unable to love. Akhtars format for differentiating the overt from the covert is an extremely helpful distinction owing to the disparity that exists among many narcissists between their self-presentations and their intrapsychic doubts. Gundersons Approach Another important contributor in the narcissistic personality literature is Gunderson (1983; Gunderson Ronningstam, 1991, Gunderson. Ronningstam, 1991 Smith. In summarizing the features of the narcissist, he includes several criteria (Gunderson Ronningstam, 1991): Narcissistic patients are usually talented and have had sustained periods of successful academic employment, or creative achievement, This is frequently a source for their sense of superiority, It is also a reason why they are more apt to appear in private practice settings than in either institutions or clinics. Narcissistically disturbed patients reported histories in which they have reacted with hostility and suspicion to the perception of other peoples envy toward them. They believe that because of envy other peoples envy toward them. They believe that because of envy other people have set out to hurt them spoil their work, diminish their achievements, or criticize them behind their back. Feelings of devaluation/or contempt may occur toward many people but are especially evident to ­ward anyone why they believe has betrayed or oth ­erwise disappointed them. These become sustained attitudes of dislike or dismissal. (pp. 114-115) Stones Approach Another astute contemporary theorist. Stone (1993) further amplifies the divergent back ­grounds and psychic states of the narcissist as the following: Narcissistic traits can develop, curiously, when there are deviations from ideal rearing on either side: pampering or neglecting; expecting too much or too little. Excessive praise of a child . . . can give rise to . . . feelings of superiority, of being destined for greatness. . . . But compensatory feel ­ings of a similar kind can arise where there has been parental indifference and neglect, for in this situation a child may develop an exaggerated de ­sire for greatness by way of shoring up a sense of self-worth in the absence of the ordinary parental praise. Whereas the overly praised child may regard himself as better than he really is, the neglected child may present a dual picture: an outward sense of (compensatory) specialness cov ­ering an inward sense worthlessness. (p. 260) Learys Approach: Timothy Leary (1957), a disciple of Homey and others of the social and interpersonal school of thought, extended their notions to what he terms adjustment through competition. Leary speaks of this pattern as demonstrating a competitive self-confident narcissism, described in the follow ­ing quotes: In its maladaptive extreme it becomes a smug, cold, selfish, exploitive social role. In this case the adaptive self-confidence and independence be ­come exaggerated into a self-oriented rejection of othersà ¢Ã¢â€š ¬Ã‚ ¦ The individuals feel most secure when they are independent of other peopleà ¢Ã¢â€š ¬Ã‚ ¦The narcissist putsà ¢Ã¢â€š ¬Ã‚ ¦distance between himself and others- wants to be independent of and superior to the other one. Dependence is terrifying. (p. 332) The second group of . . . patients . . . are those whose self-regard has received a decent defeat. They often report the most colorful and fearful symptomatology . . . The superficial impression of depression or dependence is deceptive. Psychologi ­cal testing or perceptive interviewing will reveal that the patients are not as anxious or depressed as they appear. What becomes evident is a narcissistic concern with their own reactions, their own sensi ­tivities. The precipitating cause for their entrance to the clinic is usually a shift in their life situation, which causes frustration or a blow to their pride. (p. 335) Benjamins Approach Following the interpersonal perspective of Leary are a number of interpersonally oriented theorists who drafted their model of various personality disorders in highly fruitful work. Notable among this group is Benjamin (1993), who has formulated a complex analysis of the narcis ­sistic character. In her recent work, she describes this personality as follows: There is extreme vulnerability to criticism or being ignored, together with a strong wish for love, sup ­port, and admiring deference from others. The baseline position involves noncontingent love of self and presumptive control of others. If the support is withdrawn, or if there is any evidence of lack of perfection, the self-concept degrades to severe self-criticism. Totally lacking in empathy, these persons treat others with contempt, and hold the self above and beyond the fray. (p. 147) [The narcissist] expects to be given whatever he or she wants and needs, no matter what it might mean to others. This does not include active decep ­tion, but rather is a consequence of the belief that he or she is entitled. For example, the NPD would not set out to con a little old lady out of her life savings; however, if she offered them, the NPD would accept such a gift without reflection about its impact on her. [He/She] will expect great dedication, overwork, and heroic performance from the people associated with him or her without giving any thought to the impact of this pattern in their lives. (p. 150) Beck and Freemans Approach Contributing the insightful analysis of the nar ­cissistic personality from a cognitive point of view. Beck and Freeman (1990) provide the following proposal concerning this individuals dis ­torted belief system: The core narcissistic beliefs are as follows: Since I am special, I deserve special dispensations, privi ­leges, and prerogatives, Im superior to others and they should acknowledge this, Im above the rules. Their main strategies consist of doing whatever they can to reinforce their superior status and to expand their personal domain. Thus, they may seek glory, wealth, position, power, and prestige as a way of continuously reinforcing their superior image. Their main affect is anger when other people do not accord them the admiration or respect that they believe they are entitled to, or otherwise thwart them in some way. They are prone to becom ­ing depressed, however, if their strategies are foiled. (Beck Freeman 1990. p. 50) Narcissistic Personality Disorder can be conceptualized as stemming from a combination of dysfunctional schemas about the self, the world, and the future. The early founda ­tion of these schemas is developed by direct and indirect messages from parents, siblings, and sig ­nificant others, and by experiences that mold beliefs about personal uniqueness and self-impor ­tanceà ¢Ã¢â€š ¬Ã‚ ¦ Narcissists regard themselves as spe ­cial, exceptional, and justified in focusing exclusively on personal gratification; they expect admiration, deference, and compliance from oth ­ers, and their expectations of the future focus on the realization of grandiose fantasies. At the same time, beliefs about the importance of other peoples feelings are conspicuously lacking. Be ­havior is affected by deficits in cooperation and reciprocal social interaction, as well as by ex ­cesses in demanding, self-indulgent, and some ­times aggressive behaviors. (p. 238). In writing theories of narcissistic personality disorder, the stereotyped pattern was not adopted. Rather, attempt was made to present the view of clinicians, theoreticians and social thinkers. Highlights are given below: Psycho dynamically oriented theorists conclude that the narcissistic disorders are the product of emotionally unhealthy parent child relationship. The cold and callous mother/father produce a sense of rejection and unworthiness in child with he result that such a child spends his life defending himself that he is good and loved child and he deserves admiration and attention form all others around him. Object-relation theorists are basically psychodynamically oriented. They are as a matter of fact both derivatives and deviationists. Since they give much more importance to mother-child relationship than what is commonly given to parent-child relationship, they are described as object-relation (mother-child relation) theorists. According to object-relation theorists, negative relationship between mother-child relationship has negative impact on the growing negative personality of the child. Generally such a child develops a grandiose self-image, consequently, illusion of self-sufficiency and freedom from parental restriction is reported. Such a child is much prone to narcissistic personality tendencies. Those who give importance both to behavioural and cognitive aspects or personality development do not approve the extreme sides of child-rearing practices. They approve neither too much love nor too much negligence. Extremity of approach to the child is held to be a responsible factor in the development of narcissistic disorder. In support of this proposition, first born/the only born child who is generally over-loved is said to be prone to the development of narcissistic tendencies. Socio-cultural theorists hold that in a society where freedom of living life in the way parents are living is not questioned, adolescents feel free to adopt individualistic life-pattern. In other words, narcissism is held to have link with fading interest in ones culture. That is, where individualism is preferred to collectivism, where new values are getting recognition, narcissistic lifestyle is very likely to gain strong ground. It may be summarized that articles and books have been written about narcissistic personality disorders from two opposite perspectives. The first perspective is psycho, analytic theory which suggests that personalities are compensating for inadequate affection and approval from their parents in early childhood (Kernberg, 1975; Kohut, 1972). The second perspective is social learning perspective (Millon, 1969, 1981) which holds that narcissistic personality disorders are the product of home life, created by parents who have inflated views of their childrens intelligence, achievements, and beauty of face, figure and complexion.