Diagnosing and Treating Personality Disorders
Personality disorders aren’t new, but they were first really described around the beginning of the 20th century as part of Freudian analysis. During that time, psychologists and psychiatrists were first describing a variety of personality differences that they were seeing in patients.
Although certain symptoms of mental disorders were readily identifiable, others were less clear. Personality disorders fall into that category because they are, in a sense, intrinsic to the individual. They are woven into the fabric of their personality. It makes it hard to know you have a problem because it just seems normal, and it makes it just as hard for a therapist to spot.
That doesn’t mean that people are always blind to what’s going on. Even the most defended narcissist can sometimes see their own blind spots and weaknesses. But usually, they have to want to understand why they have certain challenges in their life, and for many people with NPD, they often have trouble seeing themselves as the source of any problem.
As for the professionals who are trying to study and treat these kinds of disorders, it can also be hard to identify the specific problem. As the science reporter for the New York Times, Benedict Carey, notes, professionals need training beyond the usual education they get to spot these problems as well.
Another reason this is so problematic to identify is that people who suffer from something like narcissistic personality disorder can also have other symptoms like depression and anxiety. Those are easier to spot and tend to get treated, whereas the underlying condition ends up going undiagnosed. What’s more, even experts disagree on the specifics of each disorder.
Another problem that was pointed out by Dr. Pat Webster, clinical psychologist and author of the book Winning at Love: The Alpha Male’s Guide to Relationship Success, is that certain disorders like NPD are endemic. She argues that the US has become a “culture of narcissists.” Because of that, the traits associated with NPD often get rewarded in that context.
Moreover, there are a lot of people running around with personality disorders. Dr. Mark Lenzenweger, a psychology professor at Binghamton University, notes that approximately one in every ten Americans suffers from some kind of diagnosable personality disorder (NPR Talk of the Nation, 2012). Now, that’s not all NPD. The prevalence of NPD is estimated at approximately 0.5 percent of the general population of the United States. Interestingly, it was found in 20 percent of the military population and 17 percent of the population of first-year medical students (Sheenie Ambardar & Bienenfeld, 2019). That might reflect the success accorded certain symptoms in people who have NPD.
According to Lenzenweger, diagnosing a patient with a personality disorder involves a complicated process of sifting through their life history in order to ensure the symptoms are long-standing — i.e., have gone on for at least five years — and then separating out transitory symptoms like anxiety and depression, which can complicate the diagnosis. Only after this due diligence can the professional be certain they’re dealing with a personality disorder. Oftentimes, clinicians and patients alike don’t have that kind of time, and that’s certainly true for the loved ones who are trying to deal with the narcissist at home. Finally, to be diagnosed, the person suffering from NPD has to actually seek out treatment, and because they aren’t really aware or admit that they have a problem, this rarely happens.
If a narcissist does seek out help, the treatment they receive will vary in accordance with a number of factors. The main treatment is talk therapy, also known as psychotherapy, but the patient might also be given certain medications, particularly if they have other mental health conditions like depression.
With psychotherapy, the goal is to help the narcissist relate better to other people, so they can form and maintain more intimate and rewarding relationships. It is also designed to help them understand the causes of their emotions, why they feel the need to compete with other people, why they can’t trust others, and ultimately to get at the self-loathing that’s driving the behavior.
With time, a narcissist can learn to accept responsibility for their actions and maintain good personal relationships, successfully collaborate with coworkers, recognize their own abilities, tolerate criticism, learn from failure, regulate their emotions, build self-esteem, and let go of what they cannot control. They can also learn better coping strategies for times of stress. The support of their family and friends is a necessary element of successful treatment.
There exist no medications approved specifically for treating NPD, but clinicians will often prescribe medication for symptoms that accompany the disorder, like anxiety. There are, however, some lifestyle changes that can be implemented to help alleviate the worst of the symptoms. These include things like keeping an open mind and remembering what the goal of treatment is, sticking to the plan by attending your scheduled therapy sessions, and taking any prescribed medications as directed. They should also treat other problems like alcohol or drug abuse, as well as mental health problems, and engage in family therapy to learn new strategies for interacting with loved ones.
In sum, you can see how complex narcissistic personality disorder is, and it’s no wonder that so many people continue to suffer without any real treatment. Most of the time, they don’t even realize, or won’t admit, that they have a problem. Even if they do, getting a correct diagnosis can be a challenge, and then there’s the problem of sticking to a treatment regimen, something many narcissists simply won’t do.
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