A character in search of character: Narcissistic personality disorder and ego state therapy

American Journal of Clinical Hypnosis,  Jan 2003  by McNeal, Shirley

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The individual diagnosed with Narcissistic Personality Disorder presents with grandiosity, extreme self-involvement, and lack of interest in and empathy for others. This paper reviews current theories concerning the development and treatment of Narcissistic Personality Disorder, and introduces the use of Ego State Therapy for its treatment. The ego state model of treatment will be described and demonstrated with case material. Initially ego states that reveal the grandiosity will be accessed. As therapy progresses, ego states that hold the underlying feelings of emptiness, rage, and depression are able to emerge. With further treatment, transformation and maturation of the ego states occur, reflecting the changes in internal structure and dynamics as well as improvement in external interpersonal relationships. Issues concerning Ego State Therapy as utilized with personality disorders will be discussed and contrasted with more traditional methods of treatment.

Keywords: Character disorder, ego-strengthening, Ego State Therapy, false self, hypnosis, hypnotic age progression, narcissism, personality

The word "character" has many definitions according to Webster's Dictionary (1983). They include the following: (a) the aggregate of features and traits that form the individual nature of some person or thing, (b) moral quality or integrity, (c) an odd or eccentric person, etc. The definitions given here are only three of the ten listed. The term character is often used interchangeably with the term "personality". In the psychiatric literature, writers such as Allport (1961) opted for the term "personality" as more inclusive, indicating that in everyday language, character implied an evaluation of personality such as the phrase, "of high moral character". Allport (1961) pointed out that European psychologists preferred the term "character" while North American psychologists preferred the term "personality." Probably because of its European origins the psychoanalytic literature usually prefers "character disorder" rather than "personality disorder". Though some degree of confusion persists, according to Livesley (2001), character is usually used to refer to ". . . aspects of personality that are assumed to be the product of learning and interaction with the environment" (p.8). This definition is in contrast to the term "temperament" which refers more to genetically determined traits, although as we know this distinction is never clear-cut.

For the purposes of this paper, the words character and personality will be used interchangeably. Personality disorders have become more recognized and focused upon during the past two decades, coinciding with the publication of DSM-III in 1980 (Livesley, 2001). A personality disorder, as defined by DSM-IV TR is,

An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas: (1) cognition (i.e. ways of perceiving and interpreting self, other people, and events), (2) affectivity (i.e. the range, intensity, ]ability and appropriateness of emotional response), (3) interpersonal functioning, and (4) impulse control. The enduring pattern is inflexible and persuasive across a broad range of personal and social situations (American Psychiatric Association, 2000, p. 287).

Included in the category of personality disorders are paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent, and obsessive-compulsive personality disorder.

Narcissistic Personality Disorder

This paper will focus on the category of Narcissistic Personality Disorder whick is defined by DSM IV TR as,

A persuasive 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 (e.g. 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 situations), (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 exploitive, 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, and (9) shows arrogant, haughty behaviors or attitudes" (American Psychiatric Association, 2000, p. 294).

The Narcissistic Personality Disorder has been explored extensively from the vantage point of differing theoretical systems including traditional psychoanalytic theory, ego psychology, object relations, self psychology, and social learning theory. Writers such as Kohut (1971, 1984), Kernberg (1975, 1984), and Masterson (1981, 1985, 1988) produced the most extensive analyses of this disorder during the 1970's and 80's. More recently clinicians such as Chessick (1993), Johnson (1987, 1994), and Giovacchini (2000) have reviewed, synthesized, added to, and integrated concepts from these theories. Johnson (1987, 1994) in particular, has comprehensively presented a picture of the narcissistic personality from a developmental perspective, and his conceptualizations will be utilized extensively in this paper.