Compensatory Narcissistic Personality Disorder

The Disease Perspective

PTypes personality types proposes Compensatory Narcissistic Personality Disorder as a pervasive pattern of unstable, "overtly narcissistic behaviors [that] derive from an underlying sense of insecurity and weakness rather than from genuine feelings of self-confidence and high self-esteem" (Millon), beginning by early adulthood and present in a variety of contexts, as indicated by ten (or more) of the following:

The Dimensional Perspective

High Neuroticism

Chronic negative affects, including anxiety, fearfulness, tension, irritability, anger, dejection, hopelessness, guilt, shame; difficulty in inhibiting impulses: for example, to eat, drink, or spend money; irrational beliefs: for example, unrealistic expectations, perfectionistic demands on self, unwarranted pessimism; unfounded somatic concerns; helplessness and dependence on others for emotional support and decision making.

High Extraversion

Excessive talking, leading to inappropriate self-disclosure and social friction; inability to spend time alone; attention seeking and overly dramatic expression of emotions; reckless excitement seeking; inappropriate attempts to dominate and control others.

High Openness

Preoccupation with fantasy and daydreaming; lack of practicality; eccentric thinking (e.g., belief in ghosts, reincarnation, UFOs); diffuse identity and changing goals: for example, joining religious cult; susceptibility to nightmares and states of altered consciousness; social rebelliousness and nonconformity that can interfere with social or vocational advancement.

Low Agreeableness

Cynicism and paranoid thinking; inability to trust even friends or family; quarrelsomeness; too ready to pick fights; exploitive and manipulative; lying; rude and inconsiderate manner alienates friends, limits social support; lack of respect for social conventions can lead to troubles with the law; inflated and grandiose sense of self; arrogance.

Low Conscientiousness

Underachievement: not fulfilling intellectual or artistic potential; poor academic performance relative to ability; disregard of rules and responsibilities can lead to trouble with the law; unable to discipline self (e.g., stick to diet, exercise plan) even when required for medical reasons; personal and occupational aimlessness.

Specific Affects

The Behavior Perspective

Motivations

Wants to gain the approval of others (Reich, pp. 47, 57-58; Donaldson, pp. x, 190-197).

"Approval-seeking / Recognition-seeking [Maladaptive Schema]: Excessive emphasis on gaining approval, recognition, or attention from other people, or fitting in, at the expense of developing a secure and true sense of self. ÝOne's sense of esteem is dependent primarily on the reactions of others rather than on one's own natural inclinations. ÝSometimes includes an overemphasis on status, appearance, social acceptance, money, or achievement -- Ýas means of gaining approval, admiration, or attention (not primarily for power or control). Frequently results in major life decisions that are inauthentic or unsatisfying; Ýor in hypersensitivity to rejection" (Young).

"Delophilia: ["exhibitionism"] can be defined as the desire to express oneself and to fascinate others by one's self-exposure, to show and to impress, to merge with the other through communication" (Wurmser, pg. 158). With the delophilic drive "the subject basically wants to overpower the object by the magic force of his expressions, of his looking, talking, and thinking; he wants to fascinate, charm, mesmerize, magnetize, subjugate the other and merge with him" (pg. 165).

"Theatophilia ["idealization"] can be defined as the desire to watch and observe, to admire and to be fascinated, to merge and master through attentive looking"...(pg. 158). With the theatophilic drive "the magical force of the object is incorporated, identified with, submitted to, and merged with, with the help of looking, hearing, and being touched; one is filled with, gripped by the power of the awe-inspiring object and becomes enthusiastically enriched" (pg. 165).

Behaviors

Associated Disorders

Hypochondria (Reich, pg. 47; Mellow, pp. 14-15, 22, 280, 344, 432, 437, 441-42).

Psychosis, addictions, depression; paranoia, obsessions, compulsions, impulsivity; conversion disorder, phobia, psychosomatic symptoms, inhibition; creative inhibition, inertia; delinquent behavior, gender identity disorders, psychotic episodes; schizoid personality disorder, distantiation, racism; mid-life crisis, premature invalidism; extreme alienation, despair (Newton & Newton, pg. 482).

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The Life Story Perspective

Childhood

Cognitive Effects

Basic Belief: I must attain a position of distinction or merit. Strategy: Pretension.

Typical Beliefs/Attitudes:

Beck's Cognitive Therapy for Personality Disorders

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Baxter, David J. (1999). Erikson. Personality Theorists and their Histories. (http://www.psychlinks.ca/psy2303/lec10-1.htm).

Beck, Aaron T., Freeman, Arthur M. and Associates (1990). Cognitive Therapy of Personality Disorders. New York : Guilford Press.

Bloland, Sue Erikson (1999). Fame: The Power and Cost of a Fantasy. (http://www.theatlantic.com/issues/99nov/9911fame.htm).

Donaldson, Scott. (1983). Fool for love : a biography of F. Scott Fitzgerald. New York: Dell Publishing.

Feist, Jess (1985). Erikson: Post-Freudian Theory. Theories of Personality. 3rd. ed. Orlando, FL: Harcourt Brace.

Fitzgerald, F. Scott (1945). The Crack-Up. New York : New Directions.

Forman, Max, (1976). Narcissistic disorders and the oedipal fixations. In Feldstein, J. J., (Ed.), The Annual of Psychoanalysis. Vol. IV. pp. 65-92, New York: International Universities.

Gunderson, John G. and Philips, Katherine A. (1995). Personality Disorders. Comprehensive Textbook of Psychiatry/VI, Vol. 2. Eds. Harold I. Kaplan and Benjamin J. Sadock. Baltimore: Williams & Wilkins.

McCrae, Robert R. (1994). "A Reformulation of Axis II: Personality and Personality-Related Problems." Costa, Paul T., Jr., Widiger, Thomas A., editors. Personality Disorders and the Five-Factor Model of Personality. Washington, D.C.: The American Psychological Association.

McShane, Kathy. Developmental Theorists: Newborn to Adolescence; Erik Erikson. NU 359: Physical Assessment.

Mellow, James R. (1984). Invented Lives: F. Scott and Zelda Fitzgerald. Boston: Houghton Mifflin.

Millon, Theodore, and Roger D. Davis. Disorders of Personality: DSM-IV and Beyond. 2nd ed. New York: Wiley, 1996. pp. 411-12.

Newton, Peter M. and Newton, Dorian S. (1995). Erik H. Erikson. Comprehensive Textbook of Psychiatry/VI, Vol. 1. Eds. Harold I. Kaplan and Benjamin J. Sadock. Baltimore: Williams & Wilkins.

Reich, Annie, (1986). Pathological forms of self-esteem regulation. In Morrison, A. P., (Ed.), Essential Papers on Narcissism. pp. 44-60. Reprint from (1960) Psychoanalytic Study of the Child. Vol. 15, pp. 205-32.

Riso, Don Richard. Personality Types: Using the Enneagram for Self-discovery. Boston: Houghton Mifflin, 1987. pp. 102-3.

Sklar, Robert (1967). F. Scott Fitzgerald: The Last Laocoˆn. New York: Oxford UP.

Stavola, Thomas J. (1979). Scott Fitzgerald: Crisis in an American Identity. New York: Barnes & Noble.

Stern, Milton R. (1970). The Golden Moment: The Novels of F. Scott Fitzgerald. Urbana: University of Illinois.

Westermeyer, Robert. A Structural Model of Cognition. (http://www.habitsmart.com/struct.html).

Wurmser, Leon. (1981). The Mask of Shame. Baltimore: Johns Hopkins UP.

Young, Jeffrey (1998). Early Maladaptive Schemas and Schema Domains. (http://www.schematherapy.com/id73.htm).

The Inventive personality type is a nonpathological representation of this category.

Compensatory Narcissistic and Narcissistic Personality Disorders differentiated

In a chapter of Disorders of Narcissism : Diagnostic, Clinical, and Empirical Implications, "DSM Narcissistic Personality Disorder: historical reflections and future directions," Theodore Millon differentiates Compensatory Narcissistic from Narcissistic Personality Disorder:

The compensatory narcissistic person deviates in a fundamental way from other narcissistic subtypes, as well as from the proto-typical narcissistic person. Overtly narcissistic behaviors originate from an underlying sense of insecurity and weakness rather than from genuine feelings of self-confidence and high self-esteem. Beneath surface pseudoconfidence, this narcissistic person is driven by forces similar to those experienced by people who overtly display characteristics more akin to the negativistic and avoidant personalities.

History

Narcissism as an attitude of self-love became part of psychiatric terminology when Freud elaborated on its pathological significance in 1914. His concern was primarily with an early, predifferentiated, self-absorbed stage of development that he postulated characterizes the psychological fixation of psychotics and that offers a regressive retreat from others in the face of loss or failure. More germane to subsequent ideas about narcissistic disorders was his conception of an ego-ideal--a self-image that embodies a person's highest aspirations--and its role in determining self-esteem. [Annie] Reich extended those ideas by making self-esteem regulation central to the concept of narcissism and redefining pathological narcissism as the defensive elaboration of grandiosity in response to low self-esteem (Gunderson & Philips, pg. 1452).

Reich (1986, pg. 46) described a specific pathology:

What we loosely describe as "narcissists" are people whose libido is mainly concentrated on themselves at the expense of object love. I shall not speak here of those who without visible conflict entertain an exceedingly high opinion of themselves [ Millon's "proto-typical narcissists, as above]. Another type of narcissists frequently has exaggerated, unrealistic--i.e., infantile--inner yardsticks. The methods they use to deal with the resulting inner tension depend on the general state of their ego and often are infantile ones.

Heinz Kohut's theory of narcissism became very influential:

Narcissism assumed a central place in psychoanalytic theory and psychodynamic psychiatry in the 1970s because of the influence of Heinz Kohut. His work placed the acquisition of healthy and unhealthy narcissism into a coherent developmental framework, largely removed from phases and drives, and extended its implications into the arena of creativity, humor, and empathy--arenas of personality function that had been largely untouched by prior psychoanalytic theory. Moreover, Kohut's work lent justification and validity to clinicians' recognition of the valuable effects of the noninsightful relational experiences in psychodynamic therapies (Gunderson & Philips, pg. 1452).

Leon Wurmser (pg. 167) has reconceptualized Kohut's theory of narcissism:

This new conceptualization is seen as compatible with Freud's and Fenichel's drive theories. Kohut's theory of narcissism is conceptually reoriented so that it may be more easily connected with conflict theory and thus integrated with defense analysis.

The Sociobiology of Compensatory Narcissistic Personality Disorder

Sociobiology promises to provide more parsimonious explanations for various clinical phenomena, including personality disorders, than other models of human behavior (Cf. Antisocial personality).

Compensatory narcissism is a complex adaptive system designed to compel constant striving for higher social rank based on achievements of the intellect and imagination. It is adaptive because higher social rank brings greater access to resources and mating opportunities, greater survival and reproductive success.

Compensatory Narcissistic Personality Disorder: links

Personality Disorders

Compensatory Narcissistic Personality Disorder: Speculative Diagnostic Criteria

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