Year

2021

Degree Name

Doctor of Philosophy

Department

School of Psychology

Abstract

Narcissistic personality disorder (NPD) is a diagnosed mental health disorder that affects up to 6.2% of the population. NPD is known to have a strong interpersonal component, as individuals express their vulnerabilities to others in ways that are challenging. For instance, a person may sometimes seem grandiose and prone to intense hostility, but at other times seem vulnerable and needy, yet difficult to please. However, while the presence of interpersonal dysfunction has been identified for individuals with NPD, little is known about how this is experienced by partners and family members. This thesis presents four original studies on the impact of NPD on romantic partners and family members to progress our understanding of the disorder and improve treatment.

Method: The thesis begins with a critical review of existing literature regarding the construct of NPD to determine new research questions to be addressed (Chapter 1). Chapter 2 presents a study of partners and family in a close relationship with someone with NPD (N = 683) to assess levels of grief, burden, coping and mental health. Thematic analysis of a subset of participants' qualitative descriptions of their relative was conducted (N = 436), exploring the characteristics of the NPD relative (chapter 3) and their interpersonal interactions (chapter 4). Finally, some participants (N = 15) were asked to provide detailed narratives comparing their relationships with their relative and with others (chapter 5), to study core conflictual relationship themes (CCRTs). Chapter 6 provides an overview of research findings and outlines implications for the assessment, diagnosis and treatment of individuals with NPD, but also targeted therapeutic supports for partners and family members.

Results: Participants living with a relative with NPD were suffering significant psychological symptoms (69% depression, 82% anxiety) and high burden (chapter 2). Levels of symptoms and burden were higher than individuals living with people diagnosed with borderline personality disorder or other severe mental illness. Participant’s descriptions of their relative (chapter 3) included both “grandiose” tendencies (including entitlement, envy and exploitativeness) but also “vulnerable” ones (including hypersensitivity, insecurity and emptiness). The relationship included themes of coercive control (chapter 4), where the relative made challenging physical, verbal, emotional, financial and sexual demands. Fluctuations in idealisation, devaluation, hostility, and dependency were often present in the relationship. Relationship narratives involving relatives with pathological narcissism involved more instances of disharmony, including relatives rejecting, subjugating and attacking behaviours, and participants rejecting and withdrawing behaviours, corresponding with a deactivation of participants attachment system (chapter 5).

Conclusion: Living with a person with NPD appears to inflict a considerable psychological toll on those closest to the person. While narcissistic grandiosity, coercive control and interpersonal antagonism may serve to protect the individual who is suffering, these have an insidious effect on partners and family members. Treatments for NPD are limited, with no randomised controlled trials. The findings presented here have two major implications for therapy. First, that the disorder has severe impacts on others, meaning the mental health needs of close relatives should be assessed. Second, that therapists will need specific, targeted support to help them work with individuals with NPD, to help navigate fluctuations of grandiosity and vulnerability in this patient group, sometimes prone to being coercive, controlling and hostile, whilst also presenting as needy and insecure.

FoR codes (2020)

520302 Clinical psychology

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Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.