Utilizing Attachment Theory to Assist in the Treatment of Interpersonal Dysfunction for Narcissistic Personality Disorder

EKU Online > Utilizing Attachment Theory to Assist in the Treatment of Interpersonal Dysfunction for Narcissistic Personality Disorder

By: Meghan Semenick, M.S., EKU Clinical Psychology doctoral candidate

Narcissistic Personality Disorder (NPD) can be characterized as a pervasive pattern of grandiosity, the need for admiration, and a lack of empathy beginning by early adulthood and present in a variety of contexts. A core feature is interpersonal dysfunction, which in an extreme form can be physically, emotionally, and sexually abusive. The etiology of this disorder is rooted in the type of parenting received during childhood, which develops into an individual’s overall attachment style. Central to Attachment Theory is the concept of the internal working model, as presented by Bowlby in 1973. These are mental schemas of the self and others which guides interpersonal interactions and relationship expectations as well as generates emotional appraisals and rules for processing information. Infants develop this through identifying if their caregivers are available to provide the support and resources needed to feel soothed. If the infant’s needs are met and they feel emotionally cared for, they will develop an understanding that others can be reliable and supportive. Although, an infant that is ignored or mistreated may grow up viewing others as inaccessible and uncaring, resulting in an insecure attachment style. Attachment insecurity is associated with feelings of distress, impaired interpersonal functioning, and psychopathology, possibly leading to the development of a personality disorder. While about 50% of adults have a secure attachment, there are three forms of insecure attachment: Preoccupied, Disorganized and Dismissing.

Specifically, Preoccupied adults appear overwhelmed by negative emotions related to their relationships. Disorganized individuals exhibit lapses in reasoning due to trauma; these lapses are thought to reflect intrusions from contradictory internal working models. Finally, Dismissing adults distance themselves from close relationships, internally defending against painful feelings of rejection or disapproval. This is the predominant attachment style for individuals with NPD. Within a dismissing attachment, relational avoidance contributes to distrusting others. Typical defenses and transferences include the pervasive devaluation or brittle idealization of others as well as omnipotence and derogation of attachment related experiences and feelings.

Different forms of traumatic parenting are central to the origin of pathological narcissism. Some of these parenting qualities include inappropriate generational boundaries, shaming or humiliating the child, rejecting dependency, or failing to provide a gradual level of frustration. As an adult, those with NPD focus on regulating their self-esteem through grandiosity, which is primarily how they are viewed by others. However, there are two dissociated self-states: the grandiose self and the inferior self. Grandiose narcissism is characterized by arrogance, exhibitionism, and exploitativeness. Whereas vulnerable narcissism includes feelings of inadequacy, self-criticism, and affective lability.

Bowlby believed that attachment theory can be effectively utilized in psychotherapy. By having the therapist provide a secure base, past and present relationships can be explored. This aids in the understanding of how interactions contribute to the current internal working model. Through such exploration, patients can revise how they view themselves and others as well as develop more prosocial behaviors. While NPD, as a personality disorder, cannot be cured; it is promising that a key feature, being interpersonal dysfunction, can be treated ultimately by working to undo aspects of its etiology. An individual’s attachment style can be ascertained through the use of the Adult Attachment Inventory. Some attachment based interventions include: Attachment-Based Family Therapy, Systemic Family Therapy, and Cognitive Analytic Therapy. Therefore, by identifying adult attachment styles for individuals with NPD, appropriate attachment based interventions can be selected to treat interpersonal dysfunction. Overall, this implementation would not only help the individual, but could also prevent others from experiencing interpersonal trauma and abuse.

Meghan Semenick, M.S., is a Clinical Psychology doctoral candidate at Eastern Kentucky University

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