Narcissisticpersonality disorder (NPD) is one of the four personality disorders in ClusterB.
These four personality disorders are tied together due to similar symptoms. Peoplewith a Cluster B personality disorder are often viewed as overly emotional, self-dramatizing,and unstable. The other three Cluster B disorders are antisocial, borderline,and histrionic. NPD is characterized by a pattern of grandiosity, a constantneed of admiration, and a lack of empathy for others (Frey, 2012). According toKernberg and Kohut, the roots of NPD can be traced to disturbances in theparent-child relationship before the child turned three years old (Frey, 2012).However, Kernberg differed from Kohut in that Kernberg believed that NPD wasrooted in a defense by the child towards an unempathetic and cold parent (Frey,2012). This paper will explore Kernberg’s theory as it applies to NPD and itstreatment. As well as examine the neurobiology and diversity of NPD.
Theory Aperson’s character or personality is made up of various traits (Hertz, 2011).Some of those traits can be adaptive and useful in one situation yet dysfunctionalin another (Hertz, 2011). A person is diagnosed with a personality disorder whenthese character traits become so maladaptive and inflexible that they begin to causesignificant impairment in occupational or social functioning or cause subjectivedistress (Hertz, 2011). As previously mentioned, some of the most commoncharacteristics of NPD include having a constant need for admiration, grandiosity,and a lack of interest in anyone but themselves (Marissen, Brouwer, Hiemstra, Deen, &Franken, 2016). Other patterns of NPDinclude a very high sense of entitlement, arrogant, and feeling like they arevery “special” and can only be understood by and associate with otherhigh-status people like themselves (American Psychiatric Association, 2013). Workingwith clients with NPD can be quite difficult as they tend to feel like they canonly work with a therapist that is the best, meaning that the therapist has tobe worthy of working with them. Clients with NPD can often be rude and have adifficult time depending on the therapist which makes it challenging to workwith them as they want to maintain control of the treatment (Kernberg, 2007).
OttoKernberg’s theory on narcissism was guided by his work with patients withborderline personality disorder (Palombo, Bendicsen, & Koch, 2010). Much ofKernberg’s psychoanalytic framework included aspects of Freud’s drive theory aswell as aspects from Klein and Fairbairn’s object relations theories andJacobson’s ego psychology theory (Palombo, Bendicsen, & Koch, 2010).Kernberg concluded that there were three major tasks that children encounter (Palombo,Bendicsen, & Koch, 2010).
A child’s first major task is to identify what isself from what is other (Palombo, Bendicsen, & Koch, 2010). The secondmajor task is to conquer splitting and finally, the last major task is tocombine the good and the bad self (Palombo, Bendicsen, & Koch, 2010).Kernberg’s developmental system differed from Freud’s model in that Kernbergbelieved that the level of attained internal object relations was the basicissue in the developmental progression (Palombo, Bendicsen, & Koch, 2010). Asan expansion of the three-stage model, Kernberg proposed his theory ofdevelopment which offers a concept of normality (Palombo, Bendicsen, &Koch, 2010). For this theory ofdevelopment Kernberg proposed that development occurs in five stages. The firststage is known as normal autism or the primary undifferentiated stage whichoccurs from birth to one month. During this first stage, the child constructsprimary self-object representation from interacting with the caregiver (Palombo,Bendicsen, & Koch, 2010).
The second stage occurs from one month to 6-8months and is normal symbiosis or primary undifferentiated self-objectrepresentation. During this stage, the infant, differentiates between self andobject-images and their emerging egos (Palombo, Bendicsen, & Koch, 2010). Stage3 occurs between 6-8 months to 18-36 months of age and is calleddifferentiation of self from object representations. During this stage, thechild, begins differentiation of self and object images with the good and badobject relations and ends with the child integrating good and bad self-imagesand good and bad object-images (Palombo, Bendicsen, & Koch, 2010). Stage 4is the integration of self-representation and object-representations whichbegins at age 18-36 months and through Oedipus. Kernberg believed that duringthis stage the result is a definite self-system. Finally, stage 5 is the stageof consolidation of superego and ego integration which is the end of the Oedipusand beyond. During this stage Kernberg identified that the superego integratesinto the personality as the superego’s separateness from the ego diminishes (Palombo,Bendicsen, & Koch, 2010).
Thesecond part of Kernberg’s model is abnormal development which consists of threelevels of severity of NPD (Palombo, Bendicsen, & Koch, 2010). In the firstlevel are the mildest cases, the second level reflects the typical narcissisticwhich definitely needs treatment, and finally, the third level consists of anarcissistic patient that functions at an overt borderline level (Kernberg, 2007).According to Kernberg (2007), a patient with NPD shows some dominant featuresat the second level of severity. In the pathology of the self, a patient with NPD isvery insecure, self-centered, and over dependent on admiration from others(Kernberg, 2007). When it comes to relationships with others, the NPD patientis envious, greedy, exploitative, entitled and lacks empathy (Kernberg, 2007).
A patient with NPD is unable to commit to a relationship let alone establishjoint goals with others (Kernberg, 2007). In the pathology of the superego, theNPD patient’s self-esteem is regulated by severe mood swings, are incapable ofsadness and mourning, and are driven by a “shame” culture (Kernberg, 2007). Manypeople with NPD are constantly in a chronic sense of boredom and emptiness (Kernberg,2007). This leads a narcissistic patient to crave artificial stimulation ofaffective response (Kernberg, 2007). Someof the complications that come with people that have NPD include drug andalcohol dependence, sexual promiscuity and sexual inhibition, suicidality andparasuicidality, social parasitism, and the possibility of brief psychoticepisodes (Kernberg, 2007). This comes with pathological narcissism.
Severe narcissisticpathology occurs when the relationship no longer involves self and object but ratherinvolves a primitive and pathological grandiose self and the short-termprojection of the grandiose self onto objects (Tuttman, 1981). Accordingto Tuttman (1981), “Kernberg defines normal narcissism as the “libidinalinvestment of the self (p. 309). The self is seen as an intrapsychic structurethat consists of multiple self-representations (Tuttman, 1981). “Self-representationsare mental affective-cognitive structures in the form of images which reflectthe person’s perception of himself in real interactions with significant othersand in fantasied interactions with internal representations” (Tuttman, 1981, p.309).