Chapter 72.Narcissistic Personality Disorder

Over the years, understanding of narcissism and narcissistic personality disorder (NPD; American Psychiatric Association 2013; see Box 72-) has significantly increased. The introduction of a self-regulatory model for pathological narcissism, which captures the range from self-enhancement to inferiority and vulnerability, has opened new perspectives on approaching and understanding narcissistic personality functioning. The concept of self-agency has helped in integrating observations of the functional fluctuations, need for control, and interpersonal distancing that are typical for narcissistic patients. Recent neuroscientific research on empathic capability and emotion recognition has also added to the understanding of functional patterns and limitations in patients with NPD. Empathy is a capability with deficiencies and areas or moments of fluctuations, as well as with interactive functional components. The latter include emotion recognition and comprehension, and attunement to emotional experiences in both self and others—all affecting self-esteem regulation. Recognizing this can help in further understanding of NPD and in developing more appropriate therapeutic interventions.