Narcissistic Personality Disorder in Children and Teenagers

Narcissistic Personality Disorder in Children and Teenagers

In Greek mythology, Narcissus was a hunter who was known for his beauty. He was so proud that he disdained those who loved him, causing some to take their own lives to prove their devotion to his striking beauty. One day, Narcissus saw his own reflection in a pool of water and fell in love with his own image. Unable to leave the beauty of his reflection or disturb the pool of water for fear of losing sight of his reflection, he eventually died of thirst.

Narcissus is the origin of the term narcissism which is defined as a fixation with oneself and one’s physical appearance or public perception. Narcissism is a complex mental disorder/illness that remains throughout the lifespan; however, with appropriate treatment and management strategies, the disorder is manageable. Of interest, studies reveal that males tend to have NPD whilst females tend to be diagnosed with BPD (borderline personality disorder). *

Risk Factors
Although the exact cause of NPD is unknown, researchers believe that the following factors may influence the likelihood of a child/teenager developing NPD:

  • Family history e.g. narcissistic parents are highly likely to produce narcissistic or co-narcissistic children/teenagers
  • Parenting styles in biologically vulnerable children such as neglectful, overprotective, overindulgent, excessive criticism
  • Genetics – inherited characteristics
  • Neurobiology – the connection between brain, behaviour and thinking

Signs of NPD
Narcissistic personality disorder is related to a person’s immense love for oneself. His/her goals, desires, well being, importance, self admiration are purely self focused. Classic signs of NPD include:

  • Child/Teenager believes he/she is superior and deserve to be treated better than anyone else
  • Complete disregard for the feelings of others
  • Never expresses gratitude to parents, siblings for being kind, buying items, etc.
  • Believes everyone else is unworthy and is lower than him/her
  • Has high expectations and unreasonable expectations of others
  • Self entitlement e.g. the child/teenager feels he/she is entitled to everything asked for
  • Greatly exaggerates his/her success and personal abilities
  • Arrogant, rude
  • Inability to respect/understand needs of others
  • Opportunistic behaviour pattern, exploitive
  • Very envious of other kids achievements
  • Blames others for failures
  • Tends to be formal and aloof in personal relationships
  • Inability to listen to constructive criticism or advice and gets hurt and easily insulted
  • Pathological play
  • Separation anxiety
  • Expects peers, family, parents, teachers to adore and respect him/her
  • Gaze aversion, does not look into the eyes of the speaker
  • Difficulty making and keeping friends

A thorough assessment is required as signs of NPD are similar to antisocial personality disorder, borderline personality disorder and histrionic personality disorder. Also, narcissistic traits are commonly seen in the mental disorders psychopathy and sociopathy. The general consensus is that psychopaths are born, and sociopaths are made. Both psychopathy and sociopathy share features with narcissistic personality disorder, namely the complete lack of emotional empathy. There are four components for an accurate diagnosis of narcissistic personality disorder in children and teenagers:

1. Assessment – questionnaires, scale tests, assessment activities
2. Conversation with child re: understanding, level of self love and importance
3. Analysis of child/teen’s behaviours toward therapist, doctor, etc. Is child/teen cordial or condescending?
4. Physical examination, diagnostic tests

The most effective treatment for NPD is psychotherapy:

  • CBT (cognitive behavioural therapy) – this therapy enable child/teenager to recognise problem and identify the thought and behaviour patterns that are negative/adverse
  • Psychoanalytic psychotherapy – this therapy specifically targets the child’s grandiose self, their defence mechanisms against poor performances and poor interactions with others
  • Counselling of parents, family, siblings to learn ways to communicate/cope with conflicts, emotional distress
  • Parenting classes may also be helpful
  • Medications are rarely required unless there is a secondary mental disorder such as anxiety, depression

Potential Problems of Untreated NPD
As mentioned earlier, narcissistic personality disorder is very complex and challenging. Given that the brain is not fully developed in females until age 21 to 24 years old and age 24 to 27 years old in males, treatment will be ongoing as the child becomes a teenager, then a young adult. Challenges include:

  • Drug/alcohol abuse
  • Depression and anxiety
  • Suicidal thoughts and/or behaviour
  • Relationship problems with family, friends
  • Lack of social support network
  • Problems at school, failing grades

What Can Parents Do?
The most important thing a parent/s must remember is that behind the child/teen’s mask of extreme confidence, there lies a fragile self esteem that is vulnerable and reactive to the slightest criticism.

As a parent, you need to help your child/teen understand the dynamics of emotional/social relationships:

  • Be firm but not aggressive
  • Be patient
  • Be supportive, understanding and show love, but not too extremes. If parents tell their child/teenager they he/she is better and more special than others, the child/teen believes this and will act accordingly. To support this, a recent study found that parents who ‘overvalue’ their kids between the ages of 7 and 11 years raised children who scored higher on tests on narcissism.
  • Curb any sense of entitlement
  • Moderate conversations so child/teenager understands communication comprises 5o percent listening and 50 percent speaking
  • Be an active participant in therapy and management strategies
  • Follow up with school
  • Talk with siblings, family, friends
  • Be aware of other behaviours or changes that may indicate possible drug/alcohol abuse, depression, anxiety, suicidal thoughts
  • Report changes/concerns immediately
  • Try to maintain balance at home: chores, family time, consideration and respect of others, etc.

*Please see blog post and YouTube video #22

In my next Blog #33
I Will Discuss Mental Illness in African American Children and Teenagers

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