Narcissistic Personality Disorder and Addiction
It is estimated that about 0.5 percent of Americans are living with narcissistic personality disorder (NPD) and that NPD is the defining disorder of between 2 and 15 percent of those who seek mental health treatment, according to The American Psychiatric Publishing Textbook of Personality Disorders. The text also reports that up to 20 percent of those in the military (including narcissistic traits, says a study published in the journal Military Medicine) and 17 percent of students in their first year of medical school also struggle with the disorder.
Narcissistic personality disorder is not a small problem, and depending upon their field of study or area of expertise, it can make your loved one’s life exceedingly difficult. Generally defined by a sense of superiority and an inability to empathize with others, patients who live with narcissistic personality disorder often find it difficult to enjoy functional relationships and experience a balanced and peaceful life. Too often, if treatment is not sought, a pervading sense of dissatisfaction with life and isolation is the result. PubMed Health reports that it’s not uncommon for narcissistic personality disorder patients to seek solace in drug and alcohol abuse, and ultimately develop an addiction that can be equally debilitating.
It’s not easy to help a loved one living with narcissistic personality disorder agree to go to treatment – especially if they are living with addiction, as well – but if you can enroll them in a program that provides them with the medical and psychotherapeutic help they need, they can learn how to stop drinking or using drugs today and acquire the tools they need to manage their symptoms of narcissistic personality disorder going forward. Contact us at Alta Mira now, and speak to a counselor who can help you determine the best way to motivate your loved one to seek the treatment necessary to better their life.
What Is Narcissistic Personality Disorder?
Narcissistic personality disorder is one of 10 personality disorders that are clinically recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Between the first paper published on the subject in the early 1900s and its recognition as a clinical personality disorder in 1980, narcissistic personality disorder and its treatment has been studied and explored by a number of noted psychiatrists, including Sigmund Freud.
It is a disorder that is notoriously difficult to treat because the patient disbelieves that they have a problem that requires help. Grandiosity, entitlement, and a need for the admiration and envy of others define the disorder. Patients often feel that they are better than those around them and refuse to recognize that any way other than the way that they have chosen is the best choice.
Characterized by extreme emotionality and histrionics, narcissistic personality disorder is one of four Cluster B personality disorders that are marked by high drama. In order to receive a diagnosis, patients must exhibit at least five of the following criteria as set forth in the DSM-IV for narcissistic personality disorder:
- Sense of personal grandiosity (e.g., feeling more important than those around them and expecting to be recognized for what they perceive to be superior talents and abilities despite the lack of achievements to support such a notion)
- Preoccupation with daydreams about personal success in the arenas of finance, beauty, power, etc.
- Feelings that they are exceedingly special and should only relate to other people who are as special as they are
- Need for high amounts of respect and approval from others almost constantly
- Belief that others should prioritize their needs or desires over everything else, including their own needs
- Manipulation and exploitation of others in order to get their needs met
- Inability to empathize with the feelings or situation of another person
- Belief that others have things or accomplishments that they should have or belief that others are jealous of what they have or what they have accomplished
- Egotistical when dealing with others
Like many mental health issues, there has not yet been any scientifically identified difference in the prevalence of narcissistic personality disorder based on economic status, culture, ethnicity or race. However, it has been noted that far more men than women are diagnosed with the disease; as many as 75 percent of diagnosed patients are male, according to an article overviewing the disorder published in the American Journal of Psychiatry.
Age, too, seems to have an impact on a patient’s likelihood of experiencing narcissistic personality traits. The disorder usually onsets in early adulthood, but the symptoms may worsen with age as the patient experiences any or all of the following issues:
- Development of health problems, infirmities or disabilities
- Not reaching the career heights, financial status or notoriety they feel they deserve
- Loss of physical youth and sexual attractiveness
- Loss of employment, friends, family members, marriage, etc.
It’s important to note that while teens and adolescents may exhibit narcissistic traits as a part of their natural development, they are unlikely to go on to develop narcissistic personality disorder in adulthood.
What Is a Dual Diagnosis and How Does It Affect Narcissistic Personality Disorder Patients?
A study published in the Harvard Review of Psychiatry reports that patients who are diagnosed with narcissistic personality disorder are more likely to be diagnosed with a co-occurring mental health disorder – or a dual diagnosis. A dual diagnosis indicates the presence of more than one major mental health issue, both of which must be addressed with equal vigor in the course of a comprehensive mental health treatment program.
The study reported that the following disorders are more likely to be diagnosed in a narcissistic personality disorder patient than in the general population:
- Eating disorders, especially anorexia or other disorders defined by highly restrictive caloric intake or food choices
- Depressive disorders
- Mania or hypomania
- Anxiety and panic disorders, including phobias
- Bipolar disorder
- Obsessive-compulsive disorder (OCD)
- Other personality disorders, including borderline personality disorder, antisocial personality disorder, histrionic personality disorder, schizotypal personality disorder, and paranoid personality disorder
- Drug and alcohol abuse and addiction, especially cocaine addiction and alcoholism
When two or more mental health disorders are present in a patient, it becomes even more necessary to find an intensive treatment program that has the resources and specialists available to offer extensive medical care and intervention on all psychiatric fronts simultaneously.
Why Is Substance Abuse So Common Among Narcissistic Personality Disorder Patients?
Narcissistic personality disorder patients are rarely happy people. Their loved ones usually report that they are sarcastic, dismissive, highly critical, and rarely enjoy themselves unless they are the center of attention. Many try to increase their enjoyment of life by drinking, while others use stimulant drugs like cocaine or crystal meth to further increase their accomplishments and achievements. In general, those who struggle with co-occurring issues of depression or mood disorders may be more likely to drink while those who tend toward manic or hypomanic traits may be more likely to attempt to enhance those symptoms by using stimulant drugs.
Toby is a physicist in his late 20s. He is recently divorced and attending therapy due to a court order so he might maintain 50/50 custody of his children. While his therapist has identified narcissistic personality disorder and addiction issues, Toby is dismissive of the therapeutic process and believes that the problem lies with the court and his ex-wife, not with him. He believes that it is a disservice to his children to be raised by a woman who was working in the physics field when he met her but gave up her career to stay home, a lesser pursuit by his estimation. He does not believe she is owed child support or should be allowed to have more than visitation because he believes he is clearly the better parent because of his accomplishments. His ex-wife alleges that he should have only weekend visitation due to his drinking issues and tendency to verbally abuse her in front of the children.
While Toby freely admits that he drinks wine, as much as – and often more than – a bottle a night, he is a self-proclaimed oenophile and disagrees that his drinking impairs his judgment, parenting abilities or health, or that it causes problems at work. In reality, it is the reason that his wife left him, and he has been issued several warnings by his employer due to his long lunches, coming back to work under the influence, and frequent instability in terms of managing projects effectively.
How Is Narcissistic Personality Disorder Diagnosed?
No specific lab tests or evaluations have been approved in the diagnosis of narcissistic personality disorder, but personality tests can be helpful in the diagnostic process, according to an article published in the Journal of Personality Disorders. Often a toxicology screen is given to identify whether or not symptoms are acute and caused by drug and alcohol abuse, or chronic and co-occur with substance abuse or addiction. According to The American Psychiatric Publishing Textbook of Psychiatry, some personality tests that pose questions to the patient may be utilized during the initial evaluation period and include:
- Millon Clinical Multiaxial Inventory III (MCMI-III)
- Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II)
- Personality Diagnostic Questionnaire–4 (PDQ-4)
- Structured Interview for the DSM-IV Personality Disorders (SIDP-IV)
- International Personality Disorder Examination (IPDE)
Additionally, trained psychiatric evaluators can often identify the disorder by taking a medical and anecdotal history from the patient and family members. When narcissistic traits are reported, the evaluation process will continue in order to determine whether or not these symptoms are caused by another personality disorder, co-occurring disorders, or narcissistic personality disorder alone.
In most cases, narcissistic personality disorder is treated with intensive psychoanalytical treatment. Depending upon the nature of any co-occurring disorders, especially drug and alcohol addiction, medication and medical intervention may also be necessary as well as a wide range of psychotherapeutic options including:
- Family counseling
- Couples counseling
- Cognitive behavioral therapy
- Short-term, intensive therapies focused on addressing a specific obstacle or challenge
- Alternative and holistic treatments
Medications may also be useful in the treatment of narcissistic personality disorder. Though there are no medications approved for treatments of narcissistic symptoms or traits, the patient may benefit from medications that address issues of depression, anxiety, mood disorders, impulsivity, compulsivity and others.
It is important that treatment for narcissistic personality disorder include:
- Highly personalized care that addresses all of the symptoms that face the patient
- Extensive treatment that includes regular check-ins and follow-up care to ensure efficacy of care
- Provision of treatment by specialists who are highly educated and knowledgeable about cutting-edge treatment options and research into narcissistic personality disorder and co-occurring disorders
- Long-term follow-up care to maintain success in recovery on all mental health fronts, including substance abuse and addiction
How Do I Help My Loved One With Narcissistic Personality Disorder to Seek Treatment?
Narcissistic personality disorder is exceedingly difficult to treat due to the nature of the disorder. Few narcissistic personality disorder patients accept the idea that they would benefit from anyone’s assistance, especially in the area of mental health. Often it is necessary for them to suffer a major loss as a result of their disorder, either at home or at work. In many cases, because substance abuse is so prevalent among those living with narcissistic personality disorder, it may be easier to convince them to get treatment for their substance abuse issues at a facility that is primarily a drug rehab but that also has the ability to treat co-occurring disorders like narcissistic personality disorder as well. Choosing a moment after they have lost something important to them due to their drinking or drug use can increase the chances that they will agree to go to treatment.
If you would like to learn more about how narcissistic personality disorder is diagnosed or how substance abuse is treated when it co-occurs with narcissistic traits, or if you would like more information about how you can help your loved one move closer to accepting treatment, contact us at Alta Mira now.