Narcissistic Personality Disorder Treatment - Case Study Example

Narcissistic personality disorder Narcissistic personality disorder can be described as a condition or a state that is characterised by what is said to be an inflated sense of self importance, self involvement that is extreme, a need for admiration and being short of empathy for others. A person with this disorder will be expecting others to notice him or her as superior. The diagnosis of this disorder is made only when the above behaviours end up being more persistent and very distressing and is based on the severity and history of the systems and also psychological evaluation. There is no cause of this disorder that has been identified but an exaggerated sensitive personality and also the problems associated with parenting may have an adverse effect on the development of narcissistic personality disorder (Long, 2011). The symptoms of a person inhibiting this disorder include a situation where one takes advantage of other people with an aim of achieving his own goals, exaggeration of one’s talents and achievements, having feelings of self importance that are excessive, reaction to criticism with humiliation, range or shame and being preoccupied with the fantasies of power, intelligence, success, beauty and ideal love. In addition, this disorder makes one to pursue selfish goals, to expect unreasonable favourable treatments, to disregard others feelings and to have obsessive self interests. Treatment of a person with this disorder will hep him or her to relate in a more compassionate and positive way with other people. The complications to this disorder will be based on dependence of alcohol and other drugs, problems in work, family and relationships. The affected person will have difficulties to the adjustments of growing old and also in loosing what they see as their former superiority (A.D.A.M, 2010). Object relation The object relation theory emphasizes the interpersonal relations mainly in the family and in particular mother and child relationship. Self object is related to someone performing a necessary function for maintenance and development of a healthy and coherent sense of self. The parents are the major self objects for children and infant. According to object relation theory, a parent will act as a mirror of confirmation and acceptance of the early exhibitionism of the child and also act as a wish for acknowledgement. This means that the parent will end up shaping the development for basic striving for the child’s success and power. A parent is also the object of idealizing the needs of the child hence, reinforcing the development of goals and values for the child. Self objects will also function as models for imitation and in turn creation of a sense of belonging and alikeness between the child and the parent. Self objects that are primitive will tend to build basic structures about self skills, ambitions and ideas. Kenberg describes the pathological narcissistic of an individual as to evolve around various paradoxes that include self inflation that exists in conjunction with a need for praise which is limitless, an engaging and a charming surface which is in coverage of a ruthless interior and a self sufficiency persona which defends against the fundamental or underlying feelings of envy that is so intense (Shulman & Ferguson, 1998). In his developmental model, Kernberg says that an individual has to accomplish three developmental tasks, if there is failure to accomplish one of the developmental tasks there is an increased risk of developing certain psychopathologies. That is, failing the psychic clarification of self and others which is the first developmental task will result to a high risk of development of different psychosis. Failure to accomplish the second task which is the overcoming of splitting will lead to a high risk of developing borderline personality. Kernberg futher describes self as an intra-psychic structure that contains multiple representations of self. The realistic self is the one responsible for integration of both bad and good self images. This means that the self contains a structure which combines aggressively and libidinally invested components. He later describes the normal narcissism as self libidinal investment. However there is a need for emphasis that the self libidinal investment is not derived merely from a libidinal energy instinctual source. On the other hand, normal narcissism branches from a variety of relationships between other and self intra-psychic structures for instance the identity, ego and superego (Chambers, 2001). Kernberg classifies narcissism into three namely, the normal adult, normal infantile and pathological narcissism. The normal adult narcissism is based on self esteem of normal structures of self. In this case, the individual has object relationships that are stable, interjects the entire object representations and has a moral system that is solid. There is full development and individualization of superego. In normal infantile narcissism, the self esteem regulation will occur through age related gratifications that include normal infantile structure of demands, values and prohibitions. The other type of narcissism is pathological which has three subtypes namely regression of infantile self esteem regulation, narcissistic object choice and narcissistic personality disorder. The narcissistic personality disorder is the most suitable and severe for psychoanalysis. According to the Kernberg’s perception, narcissistic personalities are usually differentiated from both fixation and from normal adult narcissism at regression to normal infantile narcissism. Fixation at a development stage that is primitive or general lack specific intra-psychic structures development can not be adequate in explaining the narcissistic personality characteristics. Those characteristics are said to be pathological object relationships consequence. The pathological narcissism is not merely libidinal investment but is self in pathological. The pathological structure is the one that presents object images and early self defences which are either aggressively or libidinally invested (Shulman & Ferguson, 1998). According to kernberg, a narcissistic character diagnosis is dependent on the quality of the objective relations of the person and his or her intra-psychic defence patterns. Individuals who are narcissistic experience their relations with others as parasitic and exploitative. Narcissistic individuals divide the world into two, that is, those who have something that they can extract from them and the others that do not have something they can extract. They are able to distinguish between the people who are extraordinary on one hand and the others on the other hand. For instance, the extraordinary people are the ones that the narcissistic individuals will experience a sense of greatness when associated with them and the other people are what they see as worthless or mediocre. They tend to idealize the extraordinary people and disapprove those that are not extraordinary. As the narcissistic individuals idealize the extraordinary, they also fear them and as a result, they project their own exploitative wishes to them and they understand them as potentially coercive and attacking. This means that they end up being unable to rely on any fear or object that is dependent on other person making their object relations to be dissatisfying and empty (Cooper, 2006). Kernberg further says that the narcissistic individual is like the borderline character as he or she uses the defense of devaluation that is primitive, an identification that is projective, omnipotence and also primitive idealization during his or her effort in preservation of self coherence, self esteem and in combating the sense of feeling of range and envy which threatens to undermine them. The distinguishing of an individual who is narcissistic from the borderline individual is achieved through the individual’s sense of object consultancy, better professional and social functioning and better control of impulse although they may also be hollow and fragile beneath the apparent solidity surface. Although there is observed splitting on matters of defense in the narcissistic pathology, the use of defense is seen as less prominent as compared to the borderline pathology. The differentiation of pathological narcissistic from the borderline personality is made possible using the grandiose self. Using the Kernberg’s theory, grandiose self is used to represent a pathological fusion of the real self, idea self and the ideal object. The grandiose self is a structure that is defensive which is designed for self admiration maintenance and avoidance of dependence on any object that is considered real by eliminating a need for it effectively from the intra-psychic life. Although the grandiose is often toxic as observed on its effects on the relationships that are interpersonal, it also serves to maintain the otherwise coherent sense of self for the individual narcissist (Lakritz, 2009). Self psychology According to Kohut’s model on self psychology, the narcissistic psychopathology is brought about by parental lack of empathy during the child’s development. He states that the individual is not capable of developing a full capacity for regulation of self esteem. An adult who is narcissistic will be indecisive between the irrational self overestimation and irrational inferiority feelings and will rely on other people to obtain a sense of value and for self esteem regulation. Heinz Kohut stresses that, narcissistic pathology in an adult is due to lack of empathy from parental care during development. Failure to produce the empathetic feedback that is appropriate during the child development critical times will make the child lack the ability for self esteem regulation. This makes the adult to be indecisive between overestimation of self that is irrational and the inferiority feelings. However, an adult will end up relying on others in order to regulate his or her self esteem and also to give him or her sense of value in the process of searching for a feedback that is empathetic that was never received during development. Kohut believes that there are two psychological constructs that are of importance during the infant development under normal circumstances. These are the grandiose exhibitionistic self and idealized parental imago. The self grandiose exhibitionistic usually evolve into the ambitions that are self self-assured while the idealized personalized imago mostly evolve into ideas and values that are internalized. In self grandiose exhibitionistic, pathology will result in grandiosity fixation and in the idealized personalized imago, the pathology will result to deficits in such a way that the psychopathology will be rooted in fixations on idealizations that are archaic. The dyad that occurs between the parents and a child in Kohut model of self psychology is a process that is continually evolving through self object formation (McLean, 2007). Using the Kohut theory, self object contains a child that is developing in addition to the people most likely the parents that will provide the child with the abilities to maintain firmness and self structure and also a sense of steadiness and cohesion. The infant is unaware that the parents are not part of his or her self and that they are just providing the infant with functions that the infant will learn and do later on his or her own as these functions are integrated in the infant’s psychic structure. Kohut further describes three reasons that lead to lack of empathy. These are a poor fit between the parents and a child considering the characters of both, inability of the parent to nurture and to react to the child and this is usually secondary to mental and physical limitations and finally, where the child is having great self objects needs that are unusual. However, the more and earlier the failures will occur regardless of the reason, the more severe the narcissistic pathology degree and developmental arrest in an adult (Baker & Baker, 1987). In the description of the narcissistic individual’s pursuit for of the self that are unmet, Kohut explains that a certain narcissism aspect is inherent in everyone. He further gives a self description as the heart of the psychological universe. He also believes each one of us usually spends the whole life in an effort to maintain and build our self esteem by use of self objects. Kohut says that pathologic narcissism usually happen with early failures of the needs of self object in their adult lives. They are fearful of repeating or encountering their earlier past failures hence presenting with an attitude of overconfidence or superiority with reflection of the anxiety they have experienced in further self object failure encountering. This fear may also be identified in their relationships. Narcissistic personality disorder individuals usually encounter a history of relationships that have failed on the basis that the relationships are not providing them the childhood gratification that they had longed for and they also miss their needs for self object. Kohut also puts emphasis that everyone has the desire to be perfect and all of us view ourselves in a grandiose manner and these thoughts and desires are not at initial stage, subject to reality testing in the infant. With a parenting that is adequate, these ideas are lessened gradually as the time moves on through optimal frustrations or self object failures that are minor and inevitable but in real sense they are not completely destroyed. The minor frustrations are essential for the modification of the sense of self of the child but the frustrations are not traumatic psychologically. Kohut argues that it will be erroneous to believe that at all times the parents should meet the child’s self object needs as the parents themselves are also human and in addition, the parents are not with their children at all times. He further maintains that the failures are necessary in order to change the grandiose delusional ideas that are inborn because with them, the child is required to learn self sooth internal mechanisms and also maintain his or her ego even after realizing he or she is not perfect. Once the mechanisms are put in place, the child will have less reliance on self objects for praise and appreciation for self esteem regulation as the child will be able to regulate him or herself. For the narcissistic personality disorders, there was no meeting of self object needs during the individual’s childhood hence the mechanisms were never developed and the individual will go on looking for others for support of his or her self esteem. This means that the narcissistic individuals are usually very sensitive to any apparent rejection or criticism (McLean, 2007). The study of this theory has encountered both supporters and critics. The critics claim that self psychology is just a supportive psychotherapy and they are in doubt of the theory’s ability to make changes that are lasting to individuals with the narcissistic personality disorders. Some claim that it is too supportive to the narcissistic individuals in such a way that it gives them a chance to bypass their responsibilities in their conflicts. Others say that although this theory provides a broad view about narcissism and also its development, the theory is not complete and in some of the unconscious interjects of narcissistic individuals are not addressed. The say the theory can account adequately for some of the narcissism pathogenesis but the theory cannot be applied to all cases of narcissism. Instead some of the critics think that it would be better to view narcissism as behavioral syndrome which consists of different numbers of pathogenesis pathways (Ornstein & Kay, 1990). Those in support of this theory emphasize that it is an outward appearance of a psychoanalytic psychotherapy. They state that one of the vital self psychology elements which is regarded as empathy can be compared to the interpretations that are responsible for making changes that are capable of lasting. They believe that narcissistic personality disorder individual contains selves that are fragmented and they end up being unable to tolerate these interpretations earlier in therapy. Empathy as a critical tool of this theory will give allowance for the formation of therapeutic alliance in the first place. After this, the narcissistic individuals will be in a position to fill voids in their development through processing of positive experiences that occur between the individuals and those taking care of their situations. As time progresses, empathy will allow an individual who now trusts a self object to visualize beyond what can be offered by self object through idealizing or mirroring the self subject. The supporters also add that an individual will be able to make examinations of their own perceptions of situations. Once this is attained the individuals will discover developmental needs and repressed conflicts with gained ability of toleration of the interpretations which will focus on the repressed needs (Wilson, 2002). Finally, this theory consists of contributions that are lasting in the field refered to as psychoanalytic. The self psychology is currently a singular form of therapy and it is unclear if these contributions will break the therapy into contributing pieces. These contributions prove that this theory is providing a new pathway in the development of narcissism. The self of self psychology brought sense on views about narcissism. It made the word narcissism to be seen as a less dirty word. Second, the theory emphasizes the importance and need for empathy and how it can be used as a toll in solving the disorders. Third, the theory explains very clearly the transferences of self object. It also brings in front the therapist’s contributions to this field and in addition, it provides the inter-subjectivity idea (McLean, 2007). Neurobiology Narcissistic personality disorders have been found to have no specific neurobiology that is associated with symptomology. It is observed that among the personality disorders, the narcissistic personality disorder is found to receive minimal empirical attention. Researchers states that virtually no research based on neurobiology has been done on narcissistic personality disorders. Research done on other related disorders such as borderline indicate that these disorders are most likely associated with amygdale reactivity that is excessive, reduced inhibition on prefrontal and lessened serotonergic prefrontal controls facilitation. The study that looks on the biogenetic factors of narcissistic personality disorders is the twin study. The study established that entire heritability for cluster B gave a value of 0.6 for personality disorders with narcissistic personality disorders resulting to the greatest effect with a value of 0.79 of narcissistic personality. Cluster B is the group consisting most of the individuals who have personality disorders with the narcissistic individuals included. The most common feature in cluster B disorders is poor control of impulse which is an intellectual function that is complicated and it involves the brain region among others. Poor control of impulse includes a poor judgment in the evaluation of consequences resulting from decisions and lack of the ability to learn from the past experiences (Pies, 2011). The twin study found that there are genetic effects that are dominant for effective liability, dominance problems and particularly narcissism. There is no any study on the gene environment interaction to the individuals with narcissistic personality disorders as it has been for antisocial behaviors. The finding on the narcissistic personality disorders is stimulating and may end up pointing to a basis which is biogenetic for narcissistic personality disorder. This may suggest a number of neurocircuitry or neurochemical abnormalities in narcissistic personality disorders. Although the neurocircuitry and neurochemical studies have been done with the main focus on borderline personality, there is a possibility that the findings about the abnormalities and neurobiological dysfunction observed in the brain structures are no not too specific to these conditions but there can also be applied to cluster B disorders such as narcissistic personality disorders. The peculiarities include the monoaminergic systems function such as serotonin, vasopressin for aggression and impulsivity, acetylcholine for the reactivity of the mood and the brain structures which is associated to behavioral inhibition and also processing of emotional information such as cortex and amygdale (Stoffers et al., 2011). In the view of development, the prospective and retrospective studies depict associations of narcissistic personality disorder adults with child emotional and sexual abuse and also neglect. Studies done recently on borderline personality disorders moved towards the abnormal social interactions and abnormal behaviors by use of different theories. Subjects consisted of responses that are distinctive which are associated with failure of social norms recognition (Fonagy et al, 2011). Treatment The foundation of the treatment of narcissistic personality disorder is use of individual psychotherapy in particular use of psychoanalytic psychotherapy. There are other therapeutic modalities which are used for treatment of this disorder such as family, group and couples therapy and also short term objective focused and cognitive behavioral therapies. In addition, the psychotropic medications are used but not for specifically treating this disorder but they are used for the treatment of depression, concomitant anxiety, impulsivity or other disturbances of the mood. While the psychoanalytic psychotherapy for an individual is the best choose method for the narcissistic personality disorder, there has been a debate about exactly what will constitute to the optimal treatment. Kernberg’s approach based on object relations and Kohut’s approach based on self psychology provide different ways that seem contradictory on the means of approach to the narcissistic patients (Kay, 2011). According to the Kernberg’s approach based on object relations model, the work of therapist is to interpret the individual narcissistic defenses in an active manner while at the same time making illuminations of the individual’s negative transferences. The beliefs of Kernberg are that the final goal of performing therapy is to diminish or to eradicate the pathological grandiose self of an individual through direct confrontation. In contrast, Kohut on the other hand advocates for more approach on empathy where the therapist will be encouraging the grandiosity of the individual and promoting the idealization development in the transference. The final goal of Kohut is to inherently reinforce the individual’s deficient self structure (Ambardar, 2011). Due to lack of definitive study for supporting one of the therapeutic positions over the other, most of therapists nowadays have adopted a style that fuses the elements of the view points of both Kohut and Kernberg. An approach that is moderate and flexible which combines the empathetic understanding of an individual’s needs for defenses that are narcissistic and a detailed or systematic of the defenses is also preferred. Therapists should also consider that the narcissism self preserving role usually plays in the day to day life of the individual and should also observe caution on a quick tearing down of narcissistic defenses. The therapists should at the same time, strive to assist the individual in gaining of an understanding that is realistic for individual’s own behavioral deficiencies (Shedler, 2010). In addition to psychoanalytic and psychotherapy of an individual, other modalities for the disorder treatment include cognitive behavioral and group therapy. The group therapy for narcissistic individual was at first time thought as being unsuitable as the clinicians had an assumption that the individuals would not be able to handle the necessary inherent on give and take in group process. The assumption was reasonable on the grounds that the group process require patience, empathy and ability to reconnect and relate with others as these traits are deficient with narcissist individuals. On the other hand, studies have suggested that a group therapy done on long term have a therapeutic value for narcissistic individuals by giving them a safe haven for exploration of boundaries, developing trust, receiving and accepting feedback and increasing self awareness. Therapies involving cognitive behavior have also shown potential benefits to narcissistic individuals. Schema focused therapy which is a form of cognitive behavioral therapy is at the heart of repairing of defective moods and narcissistic schema and also copying styles that are associated with them. This form of treatment is work sensitive and is very active and also give confidence to the individuals in confronting distortions that are narcissistic cognitive such as white and black thinking and perfectionism. It has also depicted results that are promising in the treatment of narcissistic personality disorder (Gabbard, 1994). Diversity Within a population of people suffering from narcissistic personality disorders, the 75% of them are males. Results indicate that men show a greater prevalence of narcissistic personality disorders. The effects of narcissism on men and women are different as both place their importance on different things. Men and women suffering from this disorder have different elements from their life. Most women who are narcissistic will tend to be focused on their bodies. Women under this disorder they flaunt and exploit their femenity and also employ their physical charms very widely. They obtain their continuous feelings of superiority and admiration through their roles as mothers, wives and career women. On the other hand, men with this disorder place more importance on success, power, prestige in intellect and society and sometimes aggression. Both men and women suffering from this rely entirely on public opinion and with time, they become so sensitive about people’s perception on them. Some of their characteristics such as ego depend wholly on other people’s goodwill (Golomb et al., 1995). Men and women have under this disorder has the tendency of looking at children in a different way. For a woman, her child is basically an extension of what she is and also her continuous supply of love and admiration. This is brought about by the closeness and the interaction between the child and his or her mother. On the other hand, a child to a narcissistic man would seem to be a bother particularly during the time when a child grows and happen to be independent. Men and women suffering from this disorder will tend to react in a different way when it comes to treatment. Women have a great tendency of opting for therapy during the times when there is disturbance of their self image because they have the likelihood of talking about their problems as compared to men. However, men have a tendency of not talking about their problems and prove to be very defensive in therapy. They will never step forward and seek for help unlike women. Narcissism should not be confused with adolescent as children during this stage must display some characteristics of narcissism and this does not mean that they are suffering from it (Golomb et al., 1995). Personality aspects that are valued in some of the cultures may end up being despised in another culture. Cultures may also cultivate certain traits of personality that may look dysfunctional when viewed in another context. This means that the concept of narcissistic personality disorder may not be applicable cross culturally hence it may be bound on the culture (Schoenheit, 2010). Conclusion Narcissistic personality disorder is described as a state which is characterised by what is said to be an inflated sense of self importance, self involvement that is extreme, a need for admiration and being short of empathy for others. The diagnosis of this disorder is made only when the above behaviours end up being more persistent and very distressing and is based on psychological evaluation and severity and history of the systems. Kohut describes the anxiety and depression that narcissistic individuals feel as the deepest anxiety which a man can experience. This disorder has also been seen as overwhelming as a fear of death. Individuals experiencing this disorder feel less human when they face minor failures and they act in a narcissistic way to others in order to regain their own sense of unity. Both object relation and self psychology theories view this as a disorder originating from the parental care during chil’s development. Most of therapists have nowadays adopted a style that fuses the elements of the view points of Kohut’s and Kernberg’s models for addressing narcissistic personality disorders. Although the foundation of treatment of narcissistic personality disorder is psychoanalytic psychotherapy, other therapeutic modalities which are used for treatment of this disorder are family, group and couples therapy and also short term objective focused and cognitive behavioral therapies. References Ambardar, S. (2011). Narcissistic Personality Disorder Treatment & Management, Retrieved on 28th Nov. 2011 from: http://emedicine.medscape.com/article/1519417-treatment. A.D.A.M (2010). Narcissistic personality disorder, Retrieved on 26th Nov. 2011 from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001930/ Chambers, C.J., Bickhard, M.H. & Scott, L.G. (2001). Otto Kernberg’s Object Relations Theory: A Metapsychological Critique. Theory & Psychology, 11(5), 687–711. Baker, M & Baker H. (1987). Heinz Kohut’s self psychology: An overview. American Journal of Psychiatry, 144(1), 1–9. Cooper, Kernberg & Kohut (2006). Narcissism: Kernberg’s View of Narcissistic Personality Disorder http://www.webofnarcissism.com/forums/index.php?topic=6493.0 Fonagy,P., Luyten, P. & Strathearn, L. (2011). Borderline Personality Disorder, Mentalization, and the Neurobiology of Attachment. Infant Mental Health Journal, 32(1), 47–69. Gabbard, Glen, O., Stuart, W.T. (1994). The Role of Mother-Son Incest in the Pathogenesis of Narcissistic Personality Disorder. Journal of the American Psychoanalytic Association, 42(1), 171-189. Golomb, M., Fava, M., Abraham, M. & Rosenbaum, J.F. (1995). Gender differences in personality disorders. Am J Psychiatry. 152(4), 579-82. Kay, J. (2011). Toward a Clinically More Useful Model for Diagnosing Narcissistic Personality Disorder. Retrieved on 28th Nov. 2011 from: http://www.webofnarcissism.com/forums/index.php?topic=8301.0 McLean, J. (2007). Psychotherapy with a Narcissistic Patient Using Kohut’s Self Psychology Model, Innovations in Clinical Neuroscience. 4(1), 1-9. Lakritz, K. (2009). Kernberg’s Borderline Conditions and Pathological Narcissism. Psychiatric Times, 26(2), 15. Long, P. (2011). Narcissistic Personality Disorder, Retrieved on 26th Nov. 2011 from: http://www.mentalhealth.com/dis/p20-pe07.html Ornstein, P.H. & Kay, J. (1990). Development of psychoanalytic self psychology: A historical-conceptual overview, Review of Psychiatry. American Psychiatric Press, Inc., 303–22 PsychSPACE (2010). Otto F. Kernberg. Retrieved on 26th Nov. 2011 from: http://www.psychspace.com/psych/?action-news Pies, R. (2011). How to Eliminate Narcissism Overnight: DSM-V and the Death of Narcissistic Personality Disorder. Innov Clin Neurosci, 8(2), 23–27. Shedler, Jonathan, Beck, A., Fonagy,P., Glen O, Gunderson, J., Kernberg, O., & Westen, D. (2010). Personality Disorders in DSM-5. American Journal of Psychiatry, 167 (9), 1026–1028. Shulman, D.G. & Ferguson, G.R. (1998). An experimental investigation of Kernberg's and Kohut's theories of narcissism. J Clin Psychol , 44(3), 445-51. Schoenheit, M. (2010). Personality, Culture and Cross-Cultural Comparison, Retrieved on 26th Nov. 2011 from: http://psyclink.apa.org/display/PER/2010/11/07/Personality,+Culture+and+Cross-Cultural+Comparison. Stoffers, J.M., Ferrite, M. & Gibbon, S (2011). Pharmacological interventions for people with narcissistic personality disorder, Cochrane Database of Systematic, 10(1), 1-10 Wilson, A. & Robinson, N.M.T. (2002). Self psychology. Encyclopedia of Psychotherapy, (2)1, 615–20. Read More

This means that the self contains a structure which combines aggressively and libidinally invested components. He later describes the normal narcissism as self libidinal investment. However there is a need for emphasis that the self libidinal investment is not derived merely from a libidinal energy instinctual source. On the other hand, normal narcissism branches from a variety of relationships between other and self intra-psychic structures for instance the identity, ego and superego (Chambers, 2001).

Kernberg classifies narcissism into three namely, the normal adult, normal infantile and pathological narcissism. The normal adult narcissism is based on self esteem of normal structures of self. In this case, the individual has object relationships that are stable, interjects the entire object representations and has a moral system that is solid. There is full development and individualization of superego. In normal infantile narcissism, the self esteem regulation will occur through age related gratifications that include normal infantile structure of demands, values and prohibitions.

The other type of narcissism is pathological which has three subtypes namely regression of infantile self esteem regulation, narcissistic object choice and narcissistic personality disorder. The narcissistic personality disorder is the most suitable and severe for psychoanalysis. According to the Kernberg’s perception, narcissistic personalities are usually differentiated from both fixation and from normal adult narcissism at regression to normal infantile narcissism. Fixation at a development stage that is primitive or general lack specific intra-psychic structures development can not be adequate in explaining the narcissistic personality characteristics.

Those characteristics are said to be pathological object relationships consequence. The pathological narcissism is not merely libidinal investment but is self in pathological. The pathological structure is the one that presents object images and early self defences which are either aggressively or libidinally invested (Shulman & Ferguson, 1998). According to kernberg, a narcissistic character diagnosis is dependent on the quality of the objective relations of the person and his or her intra-psychic defence patterns.

Individuals who are narcissistic experience their relations with others as parasitic and exploitative. Narcissistic individuals divide the world into two, that is, those who have something that they can extract from them and the others that do not have something they can extract. They are able to distinguish between the people who are extraordinary on one hand and the others on the other hand. For instance, the extraordinary people are the ones that the narcissistic individuals will experience a sense of greatness when associated with them and the other people are what they see as worthless or mediocre.

They tend to idealize the extraordinary people and disapprove those that are not extraordinary. As the narcissistic individuals idealize the extraordinary, they also fear them and as a result, they project their own exploitative wishes to them and they understand them as potentially coercive and attacking. This means that they end up being unable to rely on any fear or object that is dependent on other person making their object relations to be dissatisfying and empty (Cooper, 2006). Kernberg further says that the narcissistic individual is like the borderline character as he or she uses the defense of devaluation that is primitive, an identification that is projective, omnipotence and also primitive idealization during his or her effort in preservation of self coherence, self esteem and in combating the sense of feeling of range and envy which threatens to undermine them.

The distinguishing of an individual who is narcissistic from the borderline individual is achieved through the individual’s sense of object consultancy, better professional and social functioning and better control of impulse although they may also be hollow and fragile beneath the apparent solidity surface.

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