Abnormal Psychology

612 CHAPTER 13

As for histrionic personality disorder, parents’ child-rearing practices are thought

to contribute to an adult’s subsequent narcissistic personality disorder. However,

one theory about how narcissistic personality disorder arises proposes that parents

were too attentive and permissive, leading the child to have an overinfl ated sense

of self-worth and to expect others to give him or her the same unqualifi ed positive

responses as did the parents (Millon, 1998).

Treating Narcissistic Personality Disorder

Treatment for narcissistic personality disorder is basically the same as treatment for

histrionic disorder. Again, the therapist seeks to help patients recognize and then

modify their maladaptive beliefs and strategies (as outlined in Table 13.20), using

techniques of CBT or psychodynamic therapy. However, as for all patients with

dramatic/erratic personality disorders, those with narcissistic personality disorder

usually do not remain in treatment for long—and typically continue to see other

people as the primary problem rather than their own beliefs or behaviors.

Personality Disorder View of Self View of Others Main Beliefs Main Strategies (Overt Behavior)

Histrionic Glamorous, impressive Seducible, receptive,

admiring

“I need to impress others.”

“People are there to serve and

admire me.” “People have no right

to deny me my just desserts.”

Dramatics, charm, temper tantrums,

crying; suicidal gestures

Narcissistic Special, unique; above

the rules

Inferior, admiring “I am special.” “Since I’m special,

I deserve special rules.” “I’m better

than others.”

Self-aggrandize, use others;

transcend rules; manipulate;

compete

Source: Beck, Freeman, & Davis, 2004, pp. 21, 36, 48–49.

Table 13.20 • Maladaptive Views, Beliefs, and Strategies of Individuals

with Narcissistic and Histrionic Personality Disorders

Key Concepts and Facts About Dramatic/Erratic Personality Disorders

• The hallmark of antisocial personality disorder is a persistent
  disregard for the rights of others, which may lead these people
  to violate rules or laws or to act aggressively. To be diagnosed
  with this personality disorder, an individual must have exhibited
  symptoms of conduct disorder before the age of 15.


• The diagnostic criteria for antisocial personality disorder
  overlap with aspects of psychopathy. However, psychopathy
  is defined by a more restrictive set of criteria, which focus
  on emotional and interpersonal characteristics, such as a
  lack of empathy, as well as antisocial behaviors. In contrast,
  the criteria for antisocial personality disorder tends to focus
  on behaviors, particularly criminal behaviors. More criminals
  are diagnosed with antisocial personality disorder than with
  psychopathy.


• Psychopathy and antisocial personality disorder are thought
  to arise from feedback loops among various factors, including
  genes and temperament, lack of empathy, classical and oper-
  ant conditioning, abuse or neglect or inconsistent discipline in
  childhood, parents’ criminal behavior, and attachment style.
  Treatment for psychopathy has generally not been success-
  ful; treatment for antisocial personality disorder focuses on

modifying specifi c behaviors and has some degree of success,

at least temporarily, in motivated individuals.

• Borderline personality disorder is characterized by volatile emo-
  tions, an unstable self-image, and impulsive behavior in relation-
  ships. People with this disorder have problems with emotional
  regulation—which is probably related to their temperament—and
  may engage in self-harming behaviors or try to commit suicide.


• Factors that contribute to borderline personality disorder include
  the genetic and neurological underpinnings of emotional dysreg-
  ulation, a relatively low threshold for emotional responsiveness,
  an easily changeable sense of self, cognitive distortions, and a
  history of abuse, neglect, or feeling invalidated by others.


• Treatment for borderline personality may include medication,
  CBT, DBT, intensive psychodynamic therapy, and IPT.


• The hallmark of histrionic personality disorder is attention seek-
  ing, usually through exaggerated emotional displays. Symp-
  toms may also include a sense of boredom or emptiness and a
  low tolerance for frustration.


• Narcissistic personality disorder is characterized by a grandiose
  sense of self-importance and a constant desire for praise and