A CASE OF Narcissistic Personality Disorder
By: THEODORE MILLON
et al.
Notes:
(1) Numbers mark aspects of the case most consistent with DSM
criteria as follow, and
do not necessarily indicate that the
case “meets” diagnostic criteria in this respect.
(2) Patient's name has been changed in respect to
confidentiality, and names mentioned are not of a real existent person.
Case of Gerald
Gerald stormed out of his supervisor’s office, furious that
he was on the edge of being terminated. He stubbornly resisted
the demand that
he seek counseling, asserting that the problem was the company, not him.
The immediate issue was
his strained relationship with his supervisor and the subordinates in his
office. Although his credentials were excellent, Gerald had ways of inventing new
procedures that impacted
standard routines without much sympathy for those affected. (7)
Everyone was automatically expected to follow his whim. Sometimes his novel notions
worked out, and sometimes they didn’t. (5) Regardless, the staff resented each such imposition
on their time
and their job descriptions. When things did work out for the better, Gerald gave only lip
service to the role of his coworkers. (6)
Worse, Gerald never gave up any of his ideas. He was sure
they were
superior to the “old ways” and would work if the staff could just “get their head out their
ass long enough to see the big picture and just adjust for the better.” “I do not know why
the magnitude of my
innovations isn’t obvious to everyone,” he has been heard to state. (9)
When asked how he sees himself in five years, Gerald remarks,
“I’m a firm believer in the power of positive thinking. For the most part, it’s old ways
that hold us down. Wherever I’ve gone I’ve found new ways, new efficiencies, some of them
startling. I can only
imagine that in time I will be fantastically successful. It is my
destiny.” (2)
In fact, Gerald has been pushed out at other companies for
making life
difficult, just as he is creating problems now. Others, he asserts
loudly, “either do not
recognize my ability, or else are envious when they do.” The problems with
the office staff he attributed to jealousy. “They want to get me fired so I don’t
make them all look bad. In fact, I think some of them might be deliberately
sabotaging me.” The
same was supposedly true of his supervisor. (8)
Gerald also spoke about the “cretins” he was forced to work
with, and
how their incompetence constantly delayed him from finishing his own projects and
implementing his latest ideas. (9) Having been forced to associate with inferiors all his life, he
was glad that a psychiatrist was treating him, because a medical doctor would
have a better
chance of understanding him and sympathizing with his plight. (3) Asked to name people with
whom he felt a bond, he mentioned Einstein and Salk, individuals who “had
suffered nobly for being ahead of their time, just like me.”
(1)
Gerald is the only child of a widowed mother, her “pride and
joy.” She
has told him all his life that he would do something important. Ever thinking of others, he
maintains an apartment next door so that she won’t feel “so alone.” The arrangement is
ideal: he pays no rent, she does his laundry and makes his meals, and he has all the
privacy he needs, as he
always has. Indeed, he has come to expect such treatment from everyone.
(6)
DSM-IV Criteria
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:(1) has a grandiose sense of self-importance (exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
(2) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
(3) believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
(4) requires excessive admiration
(5) has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
(6) is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
(7) lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
(8) is often envious of others or believes that others are envious of him or her
(9) shows arrogant, haughty behaviors or attitudes
References
(1) Personality Disorders in Modern Life, second edition,
2000, 2004 by John Wiley & Sons, Inc.
(2)Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition. Copyright
1994 American Psychiatric Association.
Read Also
Narcissistic Personality Disorder, Case vignette (2)
Narcissistic Personality Disorder, Case vignette (3)
Who Will Cheat?
Narcissistic Personality Disorder, Case vignette (3)
Who Will Cheat?
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