Personality and Mental Health 8: 89–90 (2014) Published online 8 January 2014 in Wiley Online Library (wileyonlinelibrary.com) DOI 10.1002/pmh.1251
Commentary Narcissistic personality disorder and becoming old
GIANCARLO DIMAGGIO, Center for Metacognitive Interpersonal Therapy, Rome, Italy Persons with Narcissistic Personality Disorder (NPD) tend to deteriorate as the years passes, and the grandiose dreams of their youth become bitter memories of their setbacks. When life ends up not being the Eden they fancied, they tend first to decline in university performance (Robins & Beer, 2001), having poor work functioning, disturbed intimate relationships and as they grow old, they can suffer to the point of resorting to substance abuse or becoming suicidal (Agrawal, Narayanan, & Oltmanns, 2013; Ronningstam & Weinberg, 2013). It is not only a decline in self-esteem that contributes to the likely deterioration these persons undergo as time passes. People with NPD features difficulties in building a sense of purpose based on their innermost wishes and are often unable to act when not driven by the quest for status. As a consequence, they experience a sense of emptiness and meaninglessness, once they are outside the arena or when they fail. Nirestean, Lukacs, Cimpan, and Nirestean (2014) provide an interesting nuance to this picture. The two women they describe, both in their seventies, present with odd thinking, which allows for a diagnosis of schizotypal personality features if not full-blown schizotypal disorder. May such an evolution towards schizotypy be possible in patients with narcissistic features? I guess it is. NPD is characterized by
Copyright © 2014 John Wiley & Sons, Ltd.
mechanisms for boosting self-esteem, which are particularly evident when they have to face negative feedbacks of setbacks (Besser & Priel, 2010), which range from self-enhancement to blaming and derogating others (Twenge & Campbell, 2003). Grandiose fantasies are such a protection mechanism and may be enacted in different ways during the life cycle: having high aspirations, recurring to fantasies of being special and connected with superior people from any epoch, distorting the self-image in order to preserve the possibility that sooner or later their grandiosity will be discovered. But, what happens when all is said and done, the limelight is lost forever and life does not offer chances for success anymore? Sure resorting to magical forces, which would allow for possible grandiosity in another world, is a possibility. Nirestean and colleagues raise the question whether that is due to the two patients being single women without children. I do not think this is the reason in itself for their shift towards schizotypy; any failure, lack of social support, and absence of a network of friends can be reasons for dramatic reactions in NPD, irrespective of sex and status. These two patients seem to me a case of a more general tendency that NPD have to suffering and deterioration over time as they are less able to resort to wishes that are deeply seated inside of
8: 89–90 (2014) DOI: 10.1002/pmh
90
Dimaggio
them instead of striving for grandiosity. Also, a man with NPD with children who had a successful life, but now is retired and children are away, might be prone to exactly the same shift. A final question raised by Nirestean and colleagues is whether these women underwent a change from grandiose to vulnerable narcissism, and these resulted in their odds beliefs that tended to cover an underlying sense of lack of self-worth. I do think this is the case, as a neat distinction between grandiose and vulnerable narcissism likely does not exist, though evidence is controversial (Dimaggio et al., 2008; Miller et al., 2011; Ronningstam & Weinberg, 2013). It is more of gure/background relationship: in a specific moment of life, grandiose features may be more evident, but a vulnerable self-image lies underneath; on the other hand, persons who tend to be introverted and apparently shy conceal feelings of grandiosity, which tend to surface if they are only given a chance (Dimaggio et al., 2002). The observations by Nirestean and colleagues may further increase the understanding of the evolution of NPD during the life cycle. They also support the idea that, when treating NPD, clinicians may focus not so much on dismantling selfenhancement. Clinicians may instead promote a sense of self based on self-fulfilment and agency over life goals connected with patients’ innermost wishes (Dimaggio & Attinà, 2012; Dimaggio et al., 2012; Ronningstam & Weinberg, 2013) References Agrawal, A., Narayanan, G., & Oltmanns, T. F. (2013). Personality pathology and alcohol dependence at midlife in a community sample. Personality disorders: theory, research and treatment, 4, 55–61.
Copyright © 2014 John Wiley & Sons, Ltd.
Besser, A., & Priel, B. (2010). Grandiose narcissism versus vulnerable narcissism in threatening situations: emotional reactions to achievement failure and interpersonal rejection. Journal of social and clinical psychology, 29, 874–902. Dimaggio, G., & Attinà, G. (2012). Metacognitive interpersonal therapy for narcissistic personality disorders with perfectionistic features: the case of Leonardo. Journal of clinical psychology: in-session, 68, 922–934. Dimaggio, G., Nicolò, G., Fiore, R., Pedone, R., Popolo, R., Centenero, E., Semerari, A., & Carcione, A. (2008). States of minds in narcissistic personality disorder. Three psychotherapy patients analysed through the Grid of Problematic States. Psychotherapy research, 18, 466–480. Dimaggio, G., Salvatore, G., Fiore, D., Carcione, A., Nicolò, G., & Semerari, A. (2012). General principles for treating the overconstricted personality disorder. Toward operationalizing technique. Journal of personality disorders, 26, 63–83. Dimaggio, G., Semerari, A., Falcone, M., Nicolò, G., Carcione, A., & Procacci, M. (2002). Metacognition, states of mind, cognitive biases and interpersonal cycles. Proposal for an integrated model of Narcissism. Journal of psychotherapy integration, 12, 421–451. Miller, J. D., Hoffman, B. J., Gaughan, E. T., Gentile, B., Maples, J., & Campbell, W. K. (2011). Grandiose and vulnerable narcissism: a nomological network analysis. Journal of personality, 79, 1013–1042. doi: 10.1111/ j.1467-6494.2010.00711.x Nirestean, A., Lukacs, E., Cimpan, C., & Nirestean, T. (2014). Narcissistic biographies – third age self-transcendence abilities. Personality and mental health, 8. Robins, R. W., & Beer, J. (2001). Positive illusions about the self: short term benefits and long-term costs. Journal of personality and social psychology, 80, 340–352. Ronningstam, E. F., & Weinberg, I. (2013). Narcissistic personality disorder: progress in recognition and treatment. Focus, 11, 167–177. Twenge, J. M., & Campbell, W. K. (2003). “Isn’t it fun to get the respect that we’re going to deserve?” Narcissism, social rejection, and aggression. Personality and social psychology bulletin, 29, 261–272.
8: 89–90 (2014) DOI: 10.1002/pmh
Commentary Narcissistic personality disorder and becoming old
GIANCARLO DIMAGGIO, Center for Metacognitive Interpersonal Therapy, Rome, Italy Persons with Narcissistic Personality Disorder (NPD) tend to deteriorate as the years passes, and the grandiose dreams of their youth become bitter memories of their setbacks. When life ends up not being the Eden they fancied, they tend first to decline in university performance (Robins & Beer, 2001), having poor work functioning, disturbed intimate relationships and as they grow old, they can suffer to the point of resorting to substance abuse or becoming suicidal (Agrawal, Narayanan, & Oltmanns, 2013; Ronningstam & Weinberg, 2013). It is not only a decline in self-esteem that contributes to the likely deterioration these persons undergo as time passes. People with NPD features difficulties in building a sense of purpose based on their innermost wishes and are often unable to act when not driven by the quest for status. As a consequence, they experience a sense of emptiness and meaninglessness, once they are outside the arena or when they fail. Nirestean, Lukacs, Cimpan, and Nirestean (2014) provide an interesting nuance to this picture. The two women they describe, both in their seventies, present with odd thinking, which allows for a diagnosis of schizotypal personality features if not full-blown schizotypal disorder. May such an evolution towards schizotypy be possible in patients with narcissistic features? I guess it is. NPD is characterized by
Copyright © 2014 John Wiley & Sons, Ltd.
mechanisms for boosting self-esteem, which are particularly evident when they have to face negative feedbacks of setbacks (Besser & Priel, 2010), which range from self-enhancement to blaming and derogating others (Twenge & Campbell, 2003). Grandiose fantasies are such a protection mechanism and may be enacted in different ways during the life cycle: having high aspirations, recurring to fantasies of being special and connected with superior people from any epoch, distorting the self-image in order to preserve the possibility that sooner or later their grandiosity will be discovered. But, what happens when all is said and done, the limelight is lost forever and life does not offer chances for success anymore? Sure resorting to magical forces, which would allow for possible grandiosity in another world, is a possibility. Nirestean and colleagues raise the question whether that is due to the two patients being single women without children. I do not think this is the reason in itself for their shift towards schizotypy; any failure, lack of social support, and absence of a network of friends can be reasons for dramatic reactions in NPD, irrespective of sex and status. These two patients seem to me a case of a more general tendency that NPD have to suffering and deterioration over time as they are less able to resort to wishes that are deeply seated inside of
8: 89–90 (2014) DOI: 10.1002/pmh
90
Dimaggio
them instead of striving for grandiosity. Also, a man with NPD with children who had a successful life, but now is retired and children are away, might be prone to exactly the same shift. A final question raised by Nirestean and colleagues is whether these women underwent a change from grandiose to vulnerable narcissism, and these resulted in their odds beliefs that tended to cover an underlying sense of lack of self-worth. I do think this is the case, as a neat distinction between grandiose and vulnerable narcissism likely does not exist, though evidence is controversial (Dimaggio et al., 2008; Miller et al., 2011; Ronningstam & Weinberg, 2013). It is more of gure/background relationship: in a specific moment of life, grandiose features may be more evident, but a vulnerable self-image lies underneath; on the other hand, persons who tend to be introverted and apparently shy conceal feelings of grandiosity, which tend to surface if they are only given a chance (Dimaggio et al., 2002). The observations by Nirestean and colleagues may further increase the understanding of the evolution of NPD during the life cycle. They also support the idea that, when treating NPD, clinicians may focus not so much on dismantling selfenhancement. Clinicians may instead promote a sense of self based on self-fulfilment and agency over life goals connected with patients’ innermost wishes (Dimaggio & Attinà, 2012; Dimaggio et al., 2012; Ronningstam & Weinberg, 2013) References Agrawal, A., Narayanan, G., & Oltmanns, T. F. (2013). Personality pathology and alcohol dependence at midlife in a community sample. Personality disorders: theory, research and treatment, 4, 55–61.
Copyright © 2014 John Wiley & Sons, Ltd.
Besser, A., & Priel, B. (2010). Grandiose narcissism versus vulnerable narcissism in threatening situations: emotional reactions to achievement failure and interpersonal rejection. Journal of social and clinical psychology, 29, 874–902. Dimaggio, G., & Attinà, G. (2012). Metacognitive interpersonal therapy for narcissistic personality disorders with perfectionistic features: the case of Leonardo. Journal of clinical psychology: in-session, 68, 922–934. Dimaggio, G., Nicolò, G., Fiore, R., Pedone, R., Popolo, R., Centenero, E., Semerari, A., & Carcione, A. (2008). States of minds in narcissistic personality disorder. Three psychotherapy patients analysed through the Grid of Problematic States. Psychotherapy research, 18, 466–480. Dimaggio, G., Salvatore, G., Fiore, D., Carcione, A., Nicolò, G., & Semerari, A. (2012). General principles for treating the overconstricted personality disorder. Toward operationalizing technique. Journal of personality disorders, 26, 63–83. Dimaggio, G., Semerari, A., Falcone, M., Nicolò, G., Carcione, A., & Procacci, M. (2002). Metacognition, states of mind, cognitive biases and interpersonal cycles. Proposal for an integrated model of Narcissism. Journal of psychotherapy integration, 12, 421–451. Miller, J. D., Hoffman, B. J., Gaughan, E. T., Gentile, B., Maples, J., & Campbell, W. K. (2011). Grandiose and vulnerable narcissism: a nomological network analysis. Journal of personality, 79, 1013–1042. doi: 10.1111/ j.1467-6494.2010.00711.x Nirestean, A., Lukacs, E., Cimpan, C., & Nirestean, T. (2014). Narcissistic biographies – third age self-transcendence abilities. Personality and mental health, 8. Robins, R. W., & Beer, J. (2001). Positive illusions about the self: short term benefits and long-term costs. Journal of personality and social psychology, 80, 340–352. Ronningstam, E. F., & Weinberg, I. (2013). Narcissistic personality disorder: progress in recognition and treatment. Focus, 11, 167–177. Twenge, J. M., & Campbell, W. K. (2003). “Isn’t it fun to get the respect that we’re going to deserve?” Narcissism, social rejection, and aggression. Personality and social psychology bulletin, 29, 261–272.
8: 89–90 (2014) DOI: 10.1002/pmh
