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 Chase
Chase
entered marital counseling at the demand of his wife, who insisted that he was
“selfish and totally preoccupied with work.” “Our world,” she states, “revolves
completely around Chase. His desires. His moods. His comfort. Everything is
catered to him.” (6)
She admits that “he’s a
good guy, basically, with talent and imagination,” but that was no longer
enough. She wanted an equal partner, someone to
spend time with, someone to feel intimate with, someone who would appreciate
her, whereas he wanted, she stated, “a mother, a maid, and an occasional sex
slave.” (7)
In
therapy, Chase seemed friendly but self-satisfied and faintly disdainful. He
talked at length about his writing, a novel that he hoped would bring him
national fame and tremendous wealth. All his time was spent working on it,
making chapters and creating dialogue. His only source of income was his
ghostwriting, from which he earned a small paycheck.
(2) “Expressing creativity,” he explained, “is my
way of fulfilling myself.” Nevertheless, he would let no one read his
masterpiece. He hinted, however, that he might show it to the therapist,
because “both of us have a deep concern for character and its development.
I
think a psychologist might be able to appreciate it.”
(3)
In
the third session of couples therapy, Chase revealed that alcoholism was an
important factor that created problems in the marriage. During occasional bouts of drinking, he became self-condemning and
irritable. Sometimes, his anger was displaced toward his wife, whom he accused
of being the cause of his failures, having seduced him into marriage, putting
obstacles in his way, and failing to appreciate the work he showed her. “She
doesn’t like anything I write!” he blurted out. “That’s not true,” she replied
in disbelief. “I like most everything you write, and when you ask for feedback,
I give it. I don’t need to lie to you, do I?” (4)
Chase
recalls an isolated childhood during which he was expected to perform above and
beyond the other children. Usually, he was successful, but occasionally
suffered tirades from his own alcoholic father, for whom “nothing was ever good
enough.” Nevertheless, for the most part, his parents regarded him as “the boy
wonder, the little genius of the family.” Peer relationships were pleasant, but
never close. Others thought of him as snobbish, an impression he admits he
still encourages, because it signified that he was “more intelligent than the
rest of the kids.” (9)
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.
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