narcissistic personality disorder case study video

Module 12: Personality Disorders

Narcissistic personality disorder, learning objectives.

• Describe the characteristics and diagnosis of narcissistic personality disorder

Now we will review  another Cluster B personality disorder: n arcissistic personality disorder.

Narcissistic personality disorder (NPD) is characterized by the personality traits of persistent grandiosity, an excessive need for admiration, and a personal disdain and lack of empathy for other people. As such, an individual with narcissistic personality disorder (NPD) usually displays arrogance and a distorted sense of personal superiority and seeks to establish abusive power and control over others. Self-confidence (a strong sense of self) is a personality trait different from the traits of narcissistic personality disorder; thus, people with narcissistic personality disorder (NPD) typically value themselves over others, to the extent of openly disregarding the wishes and feelings of anyone else, and expect to be treated as superior, regardless of their actual status or achievements. Socially, the person with NPD usually exhibits a fragile ego (self-concept), intolerance of criticism, and a tendency to belittle other people in order to validate their own superiority.

The DSM-5 indicates that a person with NPD possesses at least five of the following nine criteria, typically without possessing the commensurate personal qualities or accomplishments for which they demands respect and status:

Figure 1.  Individuals with NPD typically value themselves over anyone else.

• is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
• believes that they are special and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
• requires excessive admiration.
• has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with their expectations).
• is interpersonally exploitative (i.e., takes advantage of others to achieve their own ends).
• lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
• is often envious of others or believes that others are envious of them.
• shows arrogant, haughty behaviors or attitudes.

NPD  is a personality disorder characterized by a long-term pattern of exaggerated feelings of self-importance, an excessive craving for admiration, and struggles with empathy. People with NPD often spend much time daydreaming about achieving power and success, or on their appearance. People with the diagnosis in recent years have spoken out about its stigma in media, and possible links to abusive situations and childhood trauma. Such narcissistic behavior typically begins by early adulthood and occurs across a broad range of situations.

Epidemiology

The lifetime rates of narcissistic personality disorder are estimated at 1% in the general population; and between two to 16% in the clinical population.

Narcissistic personality disorder usually develops either in adolescence or in early adulthood,  and it is common for children and adolescents to display personality traits that resemble NPD, but such occurrences are usually transient, and register below the clinical criteria for a formal diagnosis of NPD.  True symptoms of NPD are pervasive, apparent in varied social situations, and rigidly consistent over time. Severe symptoms of NPD can significantly impair the person’s mental capabilities to develop meaningful human relationships, such as friendship, kinship, and marriage. The DSM-5 indicates that, in order to qualify as symptomatic of NPD, the person’s manifested personality traits must substantially differ from the cultural norms of society.

The causes of narcissistic personality disorder are unknown, but theorized to be linked to certain types of traumas.  A combination of genetic, environmental, and social factors are involved in narcissistic personality disorder. 

Narcissistic personality disorder usually develops either in adolescence or in early adulthood, and it is common for children and adolescents to display personality traits that resemble NPD, but such occurrences are usually transient and register below the clinical criteria for a formal diagnosis of NPD. True symptoms of NPD are pervasive, apparent in varied social situations, and are rigidly consistent over time. Severe symptoms of NPD can significantly impair the person’s mental capabilities to develop meaningful human relationships, such as friendship, kinship, and marriage. Generally, the symptoms of NPD also impair the person’s psychological abilities to function socially, either at work, or at school, or within important societal settings. The DSM-5 indicates that, in order to qualify as symptomatic of NPD, the person’s manifested personality traits must substantially differ from the cultural norms of society.

Figure 2.  NPD can give individuals inflated perceptions about themselves.

Narcissistic personality disorder is rarely the primary reason for which people seek mental health treatment. Therapy is difficult because people with narcissistic personality disorder usually do not consider their own issues as symptoms, despite mental distress. When people with NPD enter treatment, they usually are prompted by difficulties in their lives, or are seeking relief from some other disorder of their mental health, such as a major depressive disorder, drug addiction, or manic depression.

The reason for such an indirect path to psychotherapy is partly because an individually with NPD generally possess poor insight, and are unaware that their actions produced their mentally unhealthy circumstance, and so fail to recognize that their perceptions and behaviors are socially inappropriate and problematic, because of their very positive self-image (inflated self-concept).

Comorbidity

The occurrence of narcissistic personality disorder presents a high rate of comorbidity with other mental disorders. People with NPD are prone to bouts of psychological depression, often to the degree that meets the clinical criteria for a co-occurring depressive disorder. Moreover, the occurrence of NPD is further associated with the occurrence of bipolar disorder and substance use disorders, especially cocaine use disorder.

This video further explains and gives examples of narcissism.

You can view the transcript for “The psychology of narcissism – W. Keith Campbell” here (opens in new window) .

Key Takeaways: Narcissistic Personality Disorder

Case study: narcissistic personality disorder.

A 42-year-old male professional in public office, Edgar, was forced to resign after being arrested when visiting a brothel. In the aftermath, he suffered from depression, considerable alcohol consumption, and was admitted for a three-month treatment. He stopped drinking, but his depression remained unresponsive to anti-depressant medication. Still, without meaningful activities, he felt empty, restless, and was eventually referred to psychotherapy.

Developmental history indicates that at age five, Edgar’s father left the family and they did not meet again until he was in law school. He was always ahead of his age and went through school without difficulty. In law school, he got high marks without hard work. He had many acquaintances, but no close friendships, and always felt like an outsider. He got married and had two children. Reaching his mid-thirties, Edgar felt bored. He had everything: house, career, and family. He was respected and accomplished but felt he didn’t belong. He started drinking heavily and visiting brothels.

The psychotherapist found him self-assured, easily irritated, and quick to make devaluing remarks. Interactions during weekly appointments were extremely difficult. Unwilling to explore his situation or his feelings, he blamed the therapist for the impasse and told the therapist that he would not change and that the therapist could not help. The therapist dreaded the appointments, while the patient, despite finding the sessions unhelpful, always showed up. When the therapist announced a three-week break, Edgar suggested the treatment end and did not return. Nine months later, Edgar informed the therapist that he moved to another city, had a leading position working with international trade, and was greeted as a king. He said nothing about his wife and children. Nor did he indicate how he felt about the treatment.

narcissistic personality disorder:  a Cluster B personality disorder characterized by a pattern of grandiosity, a need for admiration, and a lack of empathy.

• Textbook of Psychiatry. Authored by : Wikibooks. Located at : https://en.wikibooks.org/wiki/Textbook_of_Psychiatry/Print_version#Cluster_B . License : CC BY-SA: Attribution-ShareAlike
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New Insights Into Narcissistic Personality Disorder

Despite its survival and final inclusion in DSM-5, narcissistic personality disorder remains a controversial diagnosis. Here: perspectives on diagnosis, treatment, and prognosis.

Despite its survival and final inclusion in DSM-5, narcissistic personality disorder remains a controversial diagnosis. With a lifetime prevalence of 6.2%, it is less frequently identified in psychiatric settings but more often seen in private practice and applied to higher-functioning patients. 1,2 Conceptualizations and diagnostic definitions of narcissistic personality disorder have primarily focused on the more strikingly provocative, self-enhancing, entitled interpersonal behaviors and attitudes that tend to capture the attention of clinicians rather than on the patient’s underlying, internal struggles. This has contributed to making the diagnosis more judgmental rather than informative.

Advances in understanding narcissism

One of the major advances in recent clinical and empirical studies of narcissistic personality disorder is the recognition of co-occurring vulnerability (eg, insecurity, inferiority, fragility) that accompanies emotion dysregulation. 3 Similarly, the proposed hybrid model for personality disorders in DSM-5, which includes both dimensions and central traits, incorporates evaluations of level of functioning, as well as of sense of identity, fluctuations in self- and self-esteem regulation, and empathic capability.

Research in social and personality psychology has added significantly to our general understanding of narcissism. Nevertheless, research on narcissistic psychopathology is still sparse, mainly because of low societal urgency and health costs. Signs of narcissistic personality disorder are often more noticeable within organizational, social, family, and legal or forensic settings. Patients with this personality tend to seek treatment when they are facing serious ultimatums, failures, losses, or other consequential realizations. When in treatment, they are known for their reluctance, negative therapeutic reactions, and early dropout.

Narcissistic personality disorder is often comorbid with other psychiatric disorders for which treatment is sought. However, when such conditions are present, especially substance use disorder, bipolar disorder, eating disorder, or MDD, the clinical indications of pathological narcissism in the initial psychiatric evaluation and treatment planning are likely to be less noticeable or ignored. The underlying contribution of narcissistic personality functioning to a psychiatric disorder may be totally unrecognized; this prevents remission and contributes to relapses and refusal to follow psychiatric treatment recommendations.

The nature of narcissism and its application to psychopathology

Narcissism ranges from healthy and normal to pathological and severely malignant. It is closely related to regulation of self-esteem and emotions and to a sense of control and competence. Narcissism can be a motivating factor and can contribute to exceptional and remarkable accomplishments in higher-functioning people, even when it co-occurs with pathological narcissistic traits and dimensions. It is important to recognize not only the range of pathological narcissistic functioning (ie, self-enhanced/grandiose and vulnerable/insecure), but also the areas or context of the patient’s sense of agency with competence and abilities.

When treating a patient with narcissistic personality disorder , clinicians tend to assume that competence, self-esteem, and positive interpersonal interactions are deceptive “cover-ups” or “defenses” against more severe narcissistic traits, vulnerability, or the “true self.” The patient’s mistrust, negative reactivity, and treatment discontinuation are often caused by such inferences made early in treatment. An alternative clinical approach, both in evaluation and treatment, is to encourage and collaboratively explore the patient’s own accounts of problems and experiences-and especially of fluctuations in functioning, self-esteem, identity, and interpersonal interactions. The aim is to establish a shared agreement regarding the patient’s narcissistic psychopathology and its interaction with self-esteem and interpersonal functioning.

CASE VIGNETTE 1

Mr S, an engineer in a high-tech company, describes his struggle with insecurity in certain interpersonal interactions and social contexts, especially when they involve upper management and competitive colleagues. In these situations, he begins to shake, lose cognitive flexibility, and is unable to access words and expressions. He has been struggling with this since elementary school when he had teachers who scolded him when he could not correctly answer questions, and his parents had forcefully demanded that he “suck it up” and do his best.

Mr S is perceived by his peers, friends, and family as a high-achieving, stoic, critical, demanding man who can easily make others feel insecure or even resentful. Mr S was forced to seek treatment because of his increasing alcohol abuse, which was discovered by his colleagues and immediate supervisor. For many years he had engaged in hidden, controlled but gradually increasing alcohol consumption to manage stress, insecurity, and even fear in interpersonal interactions, both at work and with his wife and son.

This vignette highlights a multifaceted interactional pattern between narcissistic personality functioning and substance use disorder, competence and fragility, internal vulnerability and external self-enhancement. Obviously, Mr S’s substance use served the function of regulating insecurity and numbing intense reactions and emotions, especially in interpersonal contexts. The aim in treatment is to engage and balance Mr S’s abilities and self-esteem, which are related to his competence and commitment, with a gradual processing of his experiences of insecurity, loss of competence, and vulnerability.

Attachment patterns in narcissistic personality disorder

Pathological narcissism and narcissistic personality disorder primarily include avoidant, preoccupied, dismissive, and “cannot classify” interactive patterns. 4 The intense preoccupation of patients with negativity, blame, and criticism, as well as their engagement in a range of strategies to manipulate, avoid, and dismiss both the clinician and certain people or contexts in their lives can contribute to stalemates, misguided interpretations, and negative enactment.

CASE VIGNETTE 2

Ms G, an intelligent woman in her mid-20s, is an inpatient in an eating disorder program. Many of the sessions with her psychotherapist are spent complaining about program conditions and the way staff and other patients treat her and making various demands (eg, need for individual attention, different treatment modalities). She also feels that the other patients get away with inappropriate behavior without consequences. When her treatment team accedes to her requests, she dismisses them and always finds faults, misguided intentions, or unacceptable conditions. She perceives efforts to help her as being detrimental to her well-being.

She feels increasingly detached and isolated in the program and begins to express sadness and crying in addition to anger and complaints. The therapist attends to her negativity. Ms G is encouraged to explore past interpersonal experiences and to talk about her sadness. She begins to give more coherent descriptions of her mother’s early death and subsequently growing up with her father. She describes numerous subtle but nevertheless challenging experiences, such as her father’s inattention alternating with intense critical responses to her behavior as well as his involvement with different girlfriends that left her feeling overpowered, unseen, and nonexistent.

Her severe eating disorder became a way for Ms G to regulate anger, to take control and gain power, and to invest in her own identity and desired self-image. Once she was able to access her underlying sadness and describe her deeply rooted and previously nonverbalized emotional experiences, she became more actively involved in her treatment. She began to eat and started engaging with some of the other patients, and she began to outline goals for her future.

This vignette demonstrates attachment patterns that can unfold and dominate the therapeutic alliance during the treatment of a patient with a co-occurring eating disorder and pathological narcissism/narcissistic personality disorder. The systematic exploration of underlying experiences and psychological trauma that contribute to reactivity and self-enhancement, as well as to dismissive, avoidant, and preoccupied interactive patterns, can alter narcissistic functioning.

The underlying contribution of narcissistic personality functioning to a psychiatric disorder may be totally unrecognized; this prevents remission and contributes to relapses and refusal to follow psychiatric treatment recommendations.

Compromised empathy

Recent studies especially in the field of neuroscience have contributed to significant reconceptualization of empathy. 5 Identified in terms of ability to understand, process, and share the emotional state and experiences of others, empathic engagement depends on both emotional contagion and cognitive theory of mind, as well as on self-regulatory processes (emotions and self-esteem), motivation, and social interpersonal skills and decisions. DSM-5 conceptualizes empathy as a dimension of personality functioning related to comprehension and appreciation of the experiences and motivations of others, tolerance of differing perspectives, and understanding of the effects of one’s behavior on others.

Clinically defined, empathy is not static; it fluctuates and is affected by a range of contextual as well as emotional, interpersonal, and neuropsychological functions. Studies have found empathic ability in narcissistic personality disorder to be compromised and fluctuating, influenced by the interaction between deficits, capabilities, and motivation. 6 More specifically, patients with narcissistic personality disorder have intact cognitive empathic ability and can identify with thoughts, feelings, and intentions of others. However, their capacity for emotional empathy is compromised, especially their ability to care about and share feelings of others.

CASE VIGNETTE 3

Ms F, a professional woman and single mother of an 8-year-old son, describes a very emotional situation at work. The young daughter of one of her colleagues had lost her battle with cancer. Everyone in the department was emotionally affected by this tragic event and engaged in various ways to console their grieving colleague. Ms F described the situation as unbearable. She was noticeably upset and frustrated as she complained about the emotional reactions of her colleagues-she felt overwhelmed and had to leave the office.

Ms F also thought that this emotional outpouring was interfering with work and misdirected attention from an important project with a looming deadline that she was in charge of. From her perspective, successfully meeting the deadline was crucial for her upcoming promotion.

The therapist begins by validating Ms F’s challenges and viewpoint and encourages her to further describe her experiences. Ms F shifts mood and perspective and says, “Don’t take me wrong, I realize that my colleague has suffered a terrible loss, and I feel for her. I signed the condolence card and donated money, but I can’t stand all these feelings-I can’t hug her and let her cry on my shoulder the way everyone else is doing.” After a moment of silence and further consideration, Ms F says, “This whole situation reminds me of when my sister suddenly died when I was 8 years old. It was a terrible event, especially for my mother, and I was told to be strong and not show any feelings. I am also afraid of losing my son . . . this whole event just became too personal.”

This vignette clarifies a range of empathic functioning, especially with regards to emotion regulation. The patient’s initial self-enhancement with immediate concerns about her own position and intense negative dismissive reactions toward her colleagues gradually tapered down as her ability for cognitive empathic understanding and concern unfolded. Furthermore, her experiences of loss and accompanying family reactions, as well as her fear of facing a similar loss, interfered with her processing of the present event.

Perspectives on treatment and prognosis

The major shift in treatment of narcissistic personality disorder occurred in the 1960s with the pioneering contributions of Heinz Kohut and Otto Kernberg, who both claimed, although with radically different approaches, that narcissistic personality disorder was treatable with psychoanalytic psychotherapy. Since then, additional treatment modalities have focused on narcissistic personality disorder-in particular transference-focused, metacognitive, and schema-focused therapies. 7-9

Patients with NPD have intact cognitive empathic ability and can identify with thoughts, feelings, and intentions of others. However, their capacity for emotional empathy is compromised.

Comorbid conditions such as mood, anxiety, and impulsivity can be treated with psychopharmacology, but there are no psychotropic medications indicated for narcissistic personality disorder. Recent research on emotion processing and regulation has contributed to our understanding of the complex interaction between narcissistic hypersensitivity and reactivity-often hidden but serving as underpinnings for more overt self-enhancing, dismissive, or avoidant interpersonal patterns. 10-13

Collaborative exploratory strategies that focus on identifying and unfolding these very individual patterns need to be considered when making treatment decisions. Alliance building and engaging the patient’s sense of agency and reflective ability are essential for change in pathological narcissism. The prognosis for narcissistic personality disorder is relative to the diagnostic definition in terms of traits versus dimensions. A recent study found a 2-year remission rate of 52.5% but high dimensional stability. 14 This finding suggests both short-term context-dependent as well as long-term enduring patterns of narcissistic personality disorder. Differentiating these patterns and identifying and applying suitable and optimal treatment strategies are still works in progress.

Disclosures:

Dr Ronningstam is Associate Professor (PT) at Harvard Medical School in Boston and Clinical Psychologist at McLean Hospital in Belmont, MA. She reports no conflicts of interest concerning the subject matter of this article.

References:

1. Stinson FS, Dawson DA, Goldstein RB, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry . 2008;69:1033-1045.

2. Zimmerman MI, Rothschild L, Chelminski I. The prevalence of DSM-IV personality disorders in psychiatric outpatients. Am J Psychiatry . 2005;162: 1911-1918.

3. Pincus AL, Lukowitsky MR. Pathological narcissism and narcissistic personality disorder. Ann Rev Clin Psychol . 2010;6:421-446.

4. Diamond D, Meehan KB. Attachment and object relations in patients with narcissistic personality disorder: implications for therapeutic process and outcome. J Clin Psychol . 2013;69:1148-1159.

5. Decety J, Moriguchi Y. The empathic brain and its dysfunction in psychiatric populations: implications for intervention across different clinical conditions. Biopsychosoc Med. 2007. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2206036/pdf/1751-0759-1-22.pdf. Accessed January 6, 2016.

6. Baskin-Sommers A, Krusemark E, Ronningstam E. Empathy in narcissistic personality disorder: from clinical and empirical perspectives. Personal Disord . 2014;5:323-333.

7. Diamond D, Yeomans FE, Stern S, et al. Transference focused psychotherapy for patients with comorbid narcissistic and borderline personality disorder. Psychoanal Inquiry . 2013;33:527-551.

8. Dimaggio G, Attinà G. Metacognitive interpersonal therapy for narcissistic personality disorder and associated perfectionism. J Clin Psychol. 2012;68:922-934.

9. Behary W, Dieckmann E. Schema therapy for narcissism: the art of empathic confrontation, limit-setting and leverage. In: Campbell K, Miller J, eds. The Handbook of Narcissism and Narcissistic Personality Disorder . New York: John Wiley & Sons; 2011:445-456.

10. Marissen MA, Deen ML, Franken IH. Disturbed emotion recognition in patients with narcissistic personality disorder. Psychiatry Res . 2012;198:269-273.

11. Ritter K, Vater A, Rüsch N, et al. Shame in patients with narcissistic personality disorder. Psychiatry Res. 2014;215:429-437.

12. Ronningstam E, Baskin-Sommers A. Fear and decision-making in narcissistic personality disorder: a link between psychoanalysis and neuroscience. Dialogues Clin Neurosci . 2013;15:191-201.

13. Ronningstam E. Pathological narcissism and narcissistic personality disorder: recent research and clinical implications. Curr Behav Neurosci Rep . In press.

14. Vater A, Ritter K, Strunz S, et al. Stability of narcissistic personality disorder: Tracking categorical and dimensional rating systems over a two-year period. Personal Disord . 2014;5:305-313.

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Case Studies: Table of Contents

A list of case studies of patients with different personality disorders. Narcissistic patient, Paranoid patient, Dependent patient and more.

• The Depressive Patient
• The Paranoid Patient
• The Psychopathic Patient
• The Narcissistic Patient  
• The Sadistic Patient
• The Masochistic Patient
• The Negativistic (Passive-Agressive) Patient
• The Dependent Patient
• The Obsessive-Compulsive Patient
• The Schizotypal Patient
• The Avoidant Patient
• The Histrionic Patient
• The Schizoid Patient
• The Borderline Patient
• Adolescent Narcissist
• Narcissism's Clarion Call - A Dream Interpreted
• Persecutory Anxiety
• The Narcissistic Personality Disorder (NPD) Catechism
• The Pathological Charmer

back to :  Malignant Self Love: Narcissism Revisited Sitemap

APA Reference Staff, H. (2009, November 15). Case Studies: Table of Contents, HealthyPlace. Retrieved on 2024, May 9 from https://www.healthyplace.com/personality-disorders/malignant-self-love/case-studies-toc

Medically reviewed by Harry Croft, MD

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6.110: Narcissistic Personality Disorder

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Name: Jenna Maroney

Source: 30 Rock (Television series, mid 2000s)

Background Information

Jenna Marony is a forty-three year old woman, who was born Ystrepa Grokovitz on February 24, 1969. She grew up in Bakersfield, CA. Her father, was a burger server in suburban Santa Barbara. He dumped Jenna’s mother, a dental hygienist, for another woman. Jenna still says she will “always be his little girl.” After being spurned, Jenna’s mother made her sit on every mall Santa’s lap in Bakersfield in an attempt to find him. Jenna has a sister who urinated in one of Jenna’s eyes when she was little, which causes it to not open all the way. Another sister is deceased. She did not get along with her half-sister, Courtney, who is now deceased. Upon hearing of her sister’s demise, Jenna showed no obvious signs of sorrow or grief. Jenna also has a niece, who draws pictures of her Auntie Jenna. Jenna finds the pictures to be offensive, when in fact they are just childlike renderings of Jenna.

During Jenna’s teen years, her mother moved what family she had left from California to Florida. Jenna attended high school on a boat, which has subsequently sunk. At the age of 16, Jenna was engaged to a congressman. She has also reportedly dated O.J. Simpson, a music producer, a sniper, a mob boss, and hinted at having been in a three-way relationship with Rosanne and Tom Arnold. Jenna’s started singing at a young age, as a distraction for her mom, who was busy shoplifting. Jenna went on to study voice at Northwestern University and also at the Royal Tampa Academy of Dramatic Tricks, where she majored in playing prom queens and murdered runaways. She has been in various films and commercial, and is currently employed as an actress on a television series.

There is no history of substance use, however, there is a history of binge eating, but the episode was brief, and Jenna’s eating habits have since returned to normal. Jenna is in good health, with no reported concerns.

Jenna seems to have coped with her life difficulties by becoming the “center of attention,” and the center of her own universe. Abandoned by her father and used by her mother as a decoy, Jenna possibly feels unloved and rejected. Jenna’s inability to empathize with others and sustain lasting relationships with are major weaknesses. She is constantly battling with someone, whether it be a co-worker, a friend or a family member. Currently, Jenna is involved with a transvestite who dresses as Jenna. In fact, Jenna met her lover while participating in a Jenna Maroney Look-Alike Contest, in which Jenna herself only placed fourth. Her new lover won the contest, and they have been intimate since that time.

Description of the Problem

Jenna does not feel she has any problems, other than not receiving the attention and recognition she feels she deserves. Her achievements are not commensurate with her desire to be “worshipped,” and adored. Jenna feels she is entitled to special treatment and when this fails to occur within her career or social life, she becomes explosive and stubborn. She has an excessive need for admiration, as evidenced by her choice of careers. She seems to have no empathy regarding others, and on the rare occasions empathy is displayed by Jenna, it is not genuine empathy, but a means to an end. In other words, she fakes empathy to manipulate others, or for personal gain. Jenna repeatedly poisoned a co-worker in the hopes of dating one of the “hot” EMT workers who came to the rescue. Jenna is severely jealous of her co-star in her current television series, and is constantly looking for ways to undermine him. She dreams of unparalleled success and believes she is the most beautiful, talented woman to grace this planet. While Jenna does not see this as a problem, the rest of society fails to agree with her assessment of herself, and this causes much frustration for Jenna. Jenna reacts very unfavorably to even the slightest criticism, as she believes herself to be perfect and unique. If she is criticized, she feels that the person doing the critique, “just doesn’t understand her,” because they are not as special and wonderful as she.

Jenna best fits the diagnostic category of Narcissistic Personality Disorder (301.81)

• has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
• is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love (perfect marriage to the perfect spouse)
• 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)
• requires excessive admiration
• has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations (“You owe me because I’m that good”)
• is inter-personally exploitative, i.e., takes advantage of others to achieve his or her own ends
• lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
• is often envious of others or believes that others are envious of him or her
• shows arrogant, haughty behaviors or attitudes
• history of intense but short-term relationships with others; inability to make or sustain genuinely intimate relationships
• a tendency to be attracted to leadership or high-profile positions or occupations
• a pattern of alternating between unrealistic idealization of others and equally unrealistic devaluation of them
• assessment of others in terms of usefulness
• a need to be the center of attention or admiration in a working group or social situation
• hypersensitivity to criticism, however mild, or rejection from others
• an unstable view of the self that fluctuates between extremes of self-praise and self-contempt
• preoccupation with outward appearance, “image,” or public opinion rather than inner reality
• painful emotions based on shame (dislike of who one is) rather than guilt (regret for what one has done)

Jenna qualifies for almost every single diagnostic criteria, as outlined in the Description of the Problem and her Background information. There is some overlap with Histrionic Personality Disorder, as Jenna does frequently use her sexuality to gain her desires, however, she fits more of the Narcissistic criteria than the HPD criterion.

Accuracy of Portrayal

The portrayal of narcissism in this character is fairly accurate, although there is some overlap with Histrionic Personality Disorder. One of the deciding factors whether this was NPD or HPD was the fact that Jenna falls in love with a man who dresses as her. Narcissus was also in love with himself and was forever doomed to gaze upon his reflection in a pool of water, until he died. It is said as his boat crossed over into the afterlife, he leaned over to catch on last glimpse of himself in the water. This is the epitome of Jenna. While more males than females are diagnosed with NPD, (7% for males and 4 % for females), Jenna is a prime example of a female narcissist.

Narcissists rarely seek treatment, as their perception is that they are “better” than everyone else. If a narcissist does enter treatment, psychotherapy is the recommended course of treatment, and perhaps some group therapy. If group therapy is utilized, clear boundaries should be set as to respecting other people in the group. Prognosis poor.

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