Narcissistic Personality Disorder in Clinical Health Psychology Practice: Case Studies of Comorbid Psychological Distress and Life-Limiting Illness

Summary & key facts

This paper looks at two real therapy patients who had narcissistic personality disorder and a serious, life-limiting illness. The authors describe how the personality disorder made medical care and therapy harder. They found patterns like refusing or resisting psychological help, not following medical advice consistently, and unstable relationships with doctors and therapists. The paper also explains therapy approaches that might help and reviews a newer way of describing personality problems used in the DSM-5. The findings come from just two cases, so they show possible problems and approaches rather than proving what works for everyone.

Key facts:

• Narcissistic personality disorder is marked by persistent grandiosity, strong needs for admiration, and fantasies of unlimited power or importance.
• Research has linked core features of the disorder to slower progress in therapy, patients leaving therapy early, and weaker relationships with therapists.
• The authors studied two psychotherapy patients with both narcissistic personality disorder and a life-limiting medical illness in a large academic clinic.
• In both cases, the disorder affected physical and emotional health by causing resistance to psychological change, inconsistent following of medical recommendations, and volatile relationships with healthcare providers.
• The paper describes psychotherapeutic methods that the authors think may help improve emotional and physical outcomes for people with both narcissistic personality disorder and serious illness, but these methods are presented as potential options rather than proven treatments.
• The authors review the DSM-5 alternative model for thinking about personality problems, which focuses on trait domains as a way to assess how personality affects functioning.

Abstract

Narcissistic Personality Disorder (NPD) is characterized by a persistent pattern of grandiosity, fantasies of unlimited power or importance, and the need for admiration or special treatment. Individuals with NPD may experience significant psychological distress related to interpersonal conflict and functional impairment. Research suggests core features of the disorder are associated with poor prognosis in therapy, including slow progress to behavioral change, premature patient-initiated termination, and negative therapeutic alliance. The current manuscript will explore challenges of working with NPD within the context of life-limiting illness for two psychotherapy patients seen in a behavioral health clinic at a large academic health science center. The ways in which their personality disorder affected their illness-experience shared significant overlap characterized by resistance to psychotherapeutic change, inconsistent adherence to medical recommendations, and volatile relationships with providers. In this manuscript we will (1) explore the ways in which aspects of narcissistic personality disorder impacted the patients' physical health, emotional well-being, and healthcare utilization; (2) describe psychotherapeutic methods that may be useful for optimizing psychosocial, behavioral, and physical well-being in individuals with co-morbid NPD and life-limiting disease; and (3) review conceptualizations of NPD from the DSM-5 alternative model for assessing personality function via trait domains.

Topics

Obsessive-Compulsive Spectrum Disorders Personality Disorders and Psychopathology Psychotherapy Techniques and Applications

Categories

Clinical Psychology Psychology Social Sciences

Tags

Biology Borderline personality disorder Clinical psychology Context (archaeology) Distress Grandiosity Narcissism Narcissistic personality disorder Paleontology Personality Personality disorders Psychiatry Psychology Psychosocial Psychotherapist Social psychology

Conditions & symptoms

Anxiety Depression Feeling disconnected from others Sadness or low mood