Narcissistic personality disorder is categorized as cluster B disorder where affected individual’s exhibit signs such as lack of empathy towards others, pervasive grandiosity pattern, excessive need for admiration, uncontrolled sense of importance and robust sense of self entitlement. Insistence of one’s innate superiority and haughty disregard for others characterizes narcissistic personality disorder. NPD begins in early childhood and manifests in a smorgasbord of contexts ( Angstman & Rasmussen, 2011) . People suffering from Cluster B personality disorders display emotional, dramatic and unpredictable demeanor. Empirical research has found family history to be a contributory factor behind people with cluster B personality disorders ( Stepp et al., 2011 ) . The study will explore the following research question; is there evidence that indicate a connection between adverse childhood experiences and development of narcissistic personality disorder?
A study by Bliton et al., (2018) , indicated that childhood verbal abuse is a causative agent which leads to development of personality disorders. During growth from adulthood through adulthood, humans develop personalities based on the surrounding environment, experiences, acquired gene characteristics and other interactions (Zhang et al., 2014). Personality trait creates the uniqueness of a person and remains unchanged over time. Exposure to early life experiences, conflict and life adaptation coupled with various unpredictabilities influence an individual’s personality development. The changes that develop early in life influence a person’s behavior in adulthood and can trigger manifestation of maladaptive personalities and related disorders. Formulation of improved treatment and assessment of narcissistic disorder requires an increased understanding of risk factors, causes and complications associated with of the personality disorder. Factors such as parenting styles, childhood abuse and neglect plays a role in manifestation of cluster B narcissistic personality disorder
Delegate your assignment to our experts and they will do the rest.
Body and Discussion
Estimates indicate that 0.5% of the United States general population suffers from narcissistic disorder. 2 to 16% of people who seek assistance from a mental health practitioners are believed to harbor narcissistic disorder symptoms. Approximately 6% of the forensic population in the US exhibits NPD symptoms. About 20% of the military population in the United States have been found to showcase narcissistic traits. An estimated 17% of students in the first medical year of study exhibit symptoms akin to those of narcissistic disorder ( Angstman & Rasmussen, 2011 ) . NPD is more prevalent in males relative to the female population. Among the individuals who are diagnosed with narcissistic personality disorder, about 75% are males. A similar study on prevalence indicated that narcissistic disorder is greater among men by 7.7% in comparison to females whose percentage is 4.8.
NPD is more prevalent among the black community, younger adults, Hispanic women, unmarried adults and individuals who are windowed, divorced or separated ( Angstman & Rasmussen, 2011 ) . Narcissistic personality disorder symptoms starts to manifest during young adulthood, that is, early to middle 20s. A decline in physical attractiveness coupled with the advent of physical infirmities may contribute to worsening of narcissistic personality disorder during old age. A feeling of intellectual and social superiority to others may contribute to progression of symptoms. Multiple studies indicate that typical adolescents who are unlikely to develop narcissistic disorder may also exhibit narcissistic tendencies.
Causes of Narcissistic Personality Disorder
Like most other mental health conditions, narcissistic personality disorder lacks a single definitive cause. Multiple research studies indicate that the exact causes of the personality disorder are not well understood which makes the mechanism by which NPD develops to remain unknown. A multiplicity of factors including how a person was raised (early parenting) and how an individual deals with stress is believed to cause the personality disorder ( Steele et al., 2019) . A number of psychodynamic theories elucidate that an unhealthy parent-child relationship is salient in the development of narcissistic personality disorder ( Angstman & Rasmussen, 2011) . Two main schools of thought from a psychoanalytic standpoint explain the cause of NPDA and include the object-relations model created by Otto Kernberg and the self-psychology framework forwarded by Heinz Kohut.
Otto Kernberg Proposition on causes of NPD
As posited by Otto Kernberg, narcissistic personality disorder is caused by having a distant and unempathetic mother. Kernberg asserts that the disorder results from having a hypercritical mother who devalues her child. Kernberg alleges that during infancy, children develop an internal representation of others people and of themselves. The object relations model claims that internal representations lead to emergence of the self-concept. The object relations serve as building blocks that motivate behavior and organize a person’s internal life. During early stages of infant development, positive object relationships build up independently from the negatively toned ones ( Hageman, et al., 2015) . Growing in an environment where there is an unloving mother leads to development of negatively toned affects that pave way for manifestation of narcissistic personality disorder. The lack integration of a loving mother and an unloving mother to represent the same person sets a foundation upon which narcissistic personality disorder occurs.
A child who has an unempathetic mother develops an internalized grandiose self to guard the inflicted emotional pain and defend the perceived lack of motherly compassion. The grandiose self which triggers manifestation of narcissistic personality disorder is composed of own positive traits, an idealized version of a loving mother and a fantastical version of herself or himself that is larger-than-life ( Hageman et al., 2015) . In accordance with the Kernberg object-relations paradigm, the child splits the needy and unlovable image inculcated by an unempathetic mother and relegates it to the unconscious self-leading to formation of a fragile sense of esteem and inferiority present in the narcissistic disorder. Consistent with Kernberg object-relations model, lack of a compassionate motherly lover coupled with hypercriticism triggers an internal object split-off representation. The child experience spurs a multiplicity of contradictory feelings which occur concomitantly. The feelings are anxiety provoking and intensely dis-orientating and prompts the person to split-off the feelings separate and from each other. The individual develops the inability to experience affectionate feelings. The mal-adaptive experience prevents the individual from cohesively integrating representations which leads to interference with personal behaviors, feelings and general functioning.
Heinz Kohut Propositions of cause of NDP
During normal psychological growth, occurrence of developmental arrest as indicated by Heinz Kohut causes narcissistic personality disorder. Kohut maintained that narcissism is an inherent feature of young children who are meant to think of themselves as the center of the universe. In reference to Kohut claims, providing appropriate praise and internalization of positive parental images play a role in development of narcissistic personality disorder ( Steele et al., 2019) . Manifestation of narcissistic traits is dependent on the twin process of mirroring coupled with idealization. If a parent fails to offer effective mirroring during infancy, a child may develop an unrealistic sense of self. Similarly, failure to provide an idealization basis during childhood may make a child stick with an initial grandiose and superiority feeling. The developmental arrest hinged on twin process mirroring and idealization eventually leads to narcissistic personality disorder.
Kohut psychological model asserts that narcissistic psychopathology occurs due to lack of parental empathy during child development. The gap created by an unloving parent impedes a child’s ability to develop full self-esteem regulation capacity. According to Kohut’s concepts, lack of parental empathy results to irrational inferiority feelings where a person relies on others for regulation of self-esteem and for derivation of sense of value. In Kohut model, failure to empathically meet a child’s self-object needs leads to developmental arrest and pathologic narcissism. Steele et al., (2019) explain that lack of parental empathy creates a poor child-parent fit in regards to disposition. Failure to react and nurture a child during developmental stages paves way for physical and mental limitations. Consequently, a child develops an unusual and great needs for self-objects.
Pervasive parental guidance and nurturing failures lead to a high degree of narcissistic traits in adults and severe developmental arrest. Early self-objects failures pushes individuals to search for gratification in adulthood missed during childhood ( Steele et al., 2019) . The patients of NPD develop fear of repeating past failures which coaxes them to present haughtiness that reflect anxiety over encountering additional self-object failures. Kohut asserts that narcissistic patients never experienced fulfilment of self-object needs, a scenario that persuades the individuals to continually look to others for reinforced self-esteem.
Genetics
Genetics contribute to development of narcissistic personality disorder. Many cases of the narcissistic personality disorders are thought to stem from inherited genetic defects. A study by Hageman et al., (2015) indicates that narcissism is inheritable although research that demonstrate how genes causes NPD is scanty. The assertion on the role played by genetics is supported by newborns in a family who showcase temperament differences in regard to reactivity and self-regulation. Previous studies indicate that the difference in temperament has a biological basis and is linked to genetics. Two views have been fronted to explain how differences in temperament cause narcissistic personality disorder. The first proposition is premised on the argument that an infants’ temperament causes problems to care providers which in turn leads to the compounding and worsening of infants’ problems which are carried to adulthood. The second view delineates that certain temperaments exposes children to environmental stressors. The two views demonstrate an association between genetic factors (temperament) and early parenting environment which likely cause narcissistic personality disorder.
The argument is supported by research findings forwarded by Steele et al., (2019) which indicated that personality traits such as NPD are up to 50% genetically determined. Additional studies have reported that heritability of narcissistic traits based on clinical samples is 77%. Reserch investigation conducted by Loper et al., (2008) explains that interpersonal entitlement and grandiosity traits are moderately heritable with each having a percentage of 23 and 35 respectively. The studies deepen the understanding of genetic heritability of narcissistic traits. Narcissistic personality disorder dimensions such as grandiosity are heritable and have environmental bases. Neuroimaging findings demonstrate that distinct environmental and genetic factors modulate narcissistic dimensions through brain regions such as right anterior insula and media orbitofrontal cortex.
Creative Achievement
Narcissistic traits are also caused by sustained periods of creative achievement or academic employment. The two act as a source of sense of superiority manifested by narcissistic individuals. According to Loper et al., (2008) creative achievement drives the individuals to aptly appear in private practice environments. The individuals are overly talented and believe that other people are envious of their creative achievements. The sustained academic employment pushes the narcissistic individuals believe that other people are set out to criticize them and diminish their achievement leading hostile and suspicious reactions towards others.
Dysfunctional Schemas
Narcissistic personality traits are conceptualized to stem from maladaptive schemas about the future, the world and self. The dysfunctional schemas develop during childhood or in adolescence and are carried throughout a person’s lifetime. The maladaptive schema is characterized by pervasive and self-defeating physical sensations, emotions and memory patterns ( Dadashzadeh et al., 2016) . The schema give rise to behaviors centered on approval seeking, grandiosity, self-sacrifice and subjugation where one holds a belief that he or she should suppress or control other people’s desires to avoid abandonment and retaliation.
Risk Factors
Childhood Experiences and Neglect
Encounters during childhood development exposes a person to the risk of presenting narcissistic traits in adulthood. A child who fails to have his or her core needs met such as affection, empathy and guidance has a high likelihood of suffering narcissistic personality disorder ( Salters, 2010 ) . An unmet needs among children create impaired abilities to control self-esteem. The end result of unaddressed needs may make a child vulnerable to narcissistic disorder. Additional childhood experiences include having a hypercritical parent and victimization by an abusive or domineering parent. Children’s behavior is learned by internalizing a parent’s voice. Children tend to identify with their parents and absorb certain characteristics exhibited by their parents during their up-bringing (Zhang et al., 2014). Children may absorb the punitive punishing voice of their parents which develop into maladaptive schemas in their adulthood. Children who identify with undesirable characteristics of a parent are at a high risk of presenting narcissistic tendencies.
Excessive Pampering
Receiving too much of a good thing exposes a child to narcissistic personality disorder. Parents who overprotect and overindulge by granting excessive autonomy and freedom to their children without limits are at risk of having the children suffer from narcissistic personality disorder. Acts of criticism, abandonment, deprivation, emotional and physical abuse during childhood pave way for development of early maladaptive schemas which increases the risk of narcissism. A new study undertaken by the Ohio State University has demonstrated that undue and constant praise towards children even for small accomplishment can create an unintended effect of an over inflated self-worth ( Salters, 2010 ) . Over-pampering can expose a child to serious narcissistic consequences later in adulthood. The social learning theory suggests that the act of overvaluing children increases the risk of narcissistic tendencies later on in life. Ascribing perfection to children and treating them as fundamentally deserving than others can have deleterious narcissistic effects in a child’s adult life.
Telling a child that he or she is better than others poses the risk of having an over inflated self-esteem and superiority over others. Lavishing praise makes children believe they are entitled to privileges ( Bliton et al., 2018) ) . Failure to obtain the admiration can make children lash our aggressively. Such children constantly crave for admiration and praise from others, a behavior they may carry to adulthood. Focusing intensely on a child’s physical appearance or an inborn talent can alter a child’s esteem resulting to an increased risk of developing narcissistic traits ( Steele et al., 2019) . Sub-groups of children who receive excessive praise but have low self-esteem are at a high risk of developing anxiety.
Child Abuse
Exposure to maltreatment such as emotional, physical, sexual and emotional abuse is associated with likelihood of developing narcissistic pathology. Tragedies such as physical abuse occurs behind closed doors at home and may expose a child to anguish and frustration. Punishing a child overly for extended periods can mold a child’s behavior to conform to that of the abusive parent. Abuse is a narcissistic parenting program that make children internalize a sense of shame and anger. Abuse during a child’s upbringing corrupts and distorts parent-child bond. Sexual, physical and psychological abuse can lead to internalization of stigma and consequently cause problems with identity and self-esteem ( Steele et al., 2019) . Narcissistic parents influence a child’s psychological development negatively through threats and emotional abuse. The undesirable child raising based on abuse is highly likely to lead to low self-esteem. The children can develop grandiosity and the need to control how others regard them. A child under a narcissistic parent is at an increased risk of developing lack of empathy.
Constant observation of a parents’ behavior would make a child learn that manipulation is necessary in getting what one wants. The child is also at risk of developing a false sense of self and may likely resort to aggression and intimidation to control others ( Loper et al., 2008) . Abuse at home leads to intense emotional control and may trigger a sense of mistrust towards others, imagined fears and identity conflict all which relate to narcissistic tendencies ( Steele et al., 2019) . Victimization in an abusive parenting relationship paves way for development of an overly inflated body image and likelihood of developing narcissistic maladaptive schemas.
Trauma
A series of emotional wounds that culminate in a major trauma exposes a person to the risk of presenting narcissistic traits. Child trauma leads to attachment dysfunction and loss of control over emotional equanimity. The end results of traumaare likely to be characterized by aggressive vindictive responses and bouts of emotional tumult. Post-traumatic stress triggers emotional dysregulation which increases the risk of narcissist emotional reaction spikes (Zhang et al., 2014). An attachment trauma that a child suffered in childhood triggers an injury that may likely convert the child into a pathological narcissist.
Cultural Factors
The seismic shift in cultural norms and practices towards self-admiration exposes people to risk of becoming narcissists. The self-admiration cultural phenomenon characterized by heightened self-esteem can be damaging and destructive due to development of narcissistic traits among individuals in a community. A culture characterized by a hedonistic urge to amass symbols of wealth increases the tendencies of narcissism. A culture where threats to acquire social symbols are numerous with constant competition encourages its individuals to harbor disregard feelings towards others. The modern world cultural underpinning is defined by individuals who advertise their happy life via social media posts and exaggerate their worth. The culture can be dangerous, disturbing, and destructive on the esteem of people who feel intimidated by the lavish lives broadcasted on social media platforms.
Complications
Relationship Difficulties
New research indicates that people who suffer from narcissistic personality disorder find conflict to be an overwhelming challenge. The individuals develop relationship insecurities for fear that their partners may abandon them in case a wrangle arises. The NPD patients may turn the fear in their relationship into a series of demanding behaviors by forcing their partners to be subservient to their wishes. Making demands to a partner likely leads to withdrawal. The individuals find it hard to accept a partner’s love fearing that clinging to a relationship would make their significant other to abandon them. Narcissistic personality disorder creates dysfunctional relationships where a person suffers reduced relationship satisfaction. The patients experience shaky and temporally relationships.
Depression and Anxiety
Majority of individuals with narcissistic personality disorder experience problems with anxiety and depression. A high comorbidity exists between narcissistic personality disorder and depression implying that individuals with NPD also suffer depression and anxiety encounters. Depression episodes among NPD patients may be triggered by interpersonal losses caused by relationship breakups. Steele et al., (2019) hypothesize that depression among NPD victims may result from the inability to deal with emotions. Narcissist individuals experience inability to effectively process feelings about themselves and those related to social situations. Negative feelings build up over time leading to depressive episodes. Narcissistic patients strive to conceal their flaws while at the same time growing distant and depressed.
Suicidal Thoughts and Behaviors
Suicidal tendencies can be an occurrence among people suffering from narcissistic disorder. Individuals with the disorder experience significant psychological distress that triggers suicidal ideation. The fears of rejection, abandonment, feelings of helplessness, anxiety and victimization are key factors of suicide ideation.
Drug and Alcohol Misuse
Narcissistic individuals may indulge in drugs and alcohol as a coping mechanism to consequences and symptoms of the disorder. Many people who present narcissistic symptoms struggle with alcohol addiction. Isolations feelings presented by narcissistic individuals compel the patients to resort to substance use. A study by Angstman and Rasmussen (2011) indicates that an estimated 40% of individuals with NPD contend with substance addiction. People with NPD turn to drugs and alcohol to seek solace, belonging, comfort and relaxation. Individuals suffering from cluster B disorders such as NPD contend with an increased substance abuse risk.
Treatment
Talk Therapy
Also known as psychotherapy, talk therapy trains an NPD individual to relate better with others and create rewarding, intimate and enjoyable relationships. Talk therapy helps the patients learn to develop positive interactions in a way that would improve various areas of their lives. The treatment entails talking to a trained professional and plays a role in enabling a person deal with negative feelings. Talk therapy employs a combination of behavioral and cognitive strategies and other drawing techniques from various theories. Talking to a therapist enables a narcissistic individual to develop a realistic image and relate better with others. The treatment method aims at enabling NPD individuals understand their disruptive thoughts, moods and behaviors. The intervention also trains the narcissistic patients how identify negative and maladaptive patterns and substitute them with positive and more productive ones.
Schema-focused Therapy
The treatment method addresses behavioral and psychological problems exhibited by narcissistic individuals. Schema therapy is an integrative approach that combines methods such as experiential, psychoanalytic and interpersonal therapies into a single unified framework ( Albers et al., 2012) . The method has demonstrated positive results in helping individuals change maladaptive patterns that trigger narcissistic traits. The treatment targets self-defeating and enduring behavioral patterns that develop in childhood.
Tranference-focussed Psychotherapy
The intervention method is based on Kernberg’s object relations theory and contemporary psychoanalytic paradigm. The treatment targets a patient’s therapeutic needs. The technique also identifies factors in a patient’s life such as alcohol and substance use that stymie administration of treatment. During transference treatment, a patient applies certain destructive feelings towards the therapist.
Conclusion
Narcissistic personality disorder is a cluster B disorder characterized by lack of empathy, inflated self-views, general sense of self-esteem and entitlement. A narcissistic person exhibits grandiosity, is pre-occupied with fantasies, requires excessive admiration and showcases haughty behaviors. Narcissistic traits stem from childhood environments characterized by abuse or neglect, digression from idea rearing and over-pampering. Excessive appraisal and high degree of freedom significantly increase the risk of developing narcissistic pathology. Excessive idealization and inadequate warmth during childhood exposes a child to development of narcissism in adulthood. Narcissistic features can also emanate from traumatization during childhood or in adolescence. The research has found multiple credible research indicating an association between adverse childhood experiences and narcissistic personality disorder. Relationship difficulties, drug and substance abuse, suicidal behaviors, depression and anxiety are complications that arise from NPD. Talk therapy, schema focused therapy and Tranference-focussed psychotherapy are treatment methods that help NPD individuals achieve behavior change.
References
Albers, C., Minderaa, R., Emmelkamp, P., Nauta, M., & Schuppert, M. (2012). Parental rearing and psychopathology in mothers of adolescents with and without borderline personality symptoms. Child and Adolescent Psychiatry and Mental Health , 29 (6). https://capmh.biomedcentral.com/articles/10.1186/1753-2000-6-29
Angstman, K. B., & Rasmussen, N. H. (2011). Personality disorders: Review and clinical application in daily practice. American Family Physician , 84 (11), 1254-1260. https://www.aafp.org/afp/2011/1201/p1253.pdf
Bliton , Emily, C. F., Dowgwillo, E. A., Dawood, S. & Pincus, A. L. (2018). Personality disorder. In V. Ziegler-Hill, T.K. Shackelford (eds). Encyclopedia of personality and individual differences (pp. 1-15). Springer International Publishing .
Dadashzadeh, H., Hekmati, I., Gholizadeh, H. & Abdi, R. (2016). Schema modes in cluster B personality disorders. Archives of Psychiatry and Psychotherapy , 2 (2), 22-28. https://www.researchgate.net/publication/305392227_Schema_modes_in_cluster_B_personality_disorders
Hageman, T., Francis, A., Field, A., & Carr, S. (2015). Links between childhood experiences and avoidant personality disorder symptomatology. International Journal of Psychology and Psychological Therapy , 15 (1), 101-116.
Loper, A. B., Mahmoodzadegan, N., & Warren, J. I. (2008). Childhood maltreatment and cluster b personality pathology in female serious offenders. Sexual Abuse A Journal of Research and Treatment , 20 (2), 139-160.
Salters, K. (2010, January 12). Understanding cluster B personality disorders in the DSM-5 . Verywell Mind . https://www.verywellmind.com/the-cluster-b-personality-disorders-425429
Steele, K. R., Townsend, M. L., & Grenyer, B. F. (2019). Parenting and personality disorder: An overview and meta-synthesis of systematic reviews. Plosone . https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0223038
Stepp, S., Whalen, D., Pilkonis, P., Hipwell, A., & Levine, M. (2011). Children of mothers with borderline personality disorder: Identifying parenting behaviors as potential targets for intervention. Personal Disord , 3 (1), 76-91. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3268672/
Zhang, T., Chow, A., Dai, L., & Xiaoa, Z. (2014). The Role of childhood traumatic experience in personality disorders in china. Comprehensive Psychiatry , 53 (6), 828-836. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159500/
