APC: Narcissism
APC: Narcissism is organized by American Academy of Addiction Psychiatry (AAAP).
Expires on Dec 01, 2025
Description:
Maladaptive personality styles, particularly antagonistic patterns such as narcissism, can significantly complicate assessment, treatment, and long-term management with individuals living with substance use disorders. Relational and intrapsychic dynamics such as denial can present as part of both substance use and antagonistic personality styles, and we also observe significant interpersonal disruption which will impact treatment engagement and relapse management. Very little empirical research has addressed the overlap between narcissism or NPD and substance use, however, most clinicians recognize that these patterns can complicate treatment significantly. Nonetheless, formal assessment of personality variables as a part of treatment planning is often lacking. This presentation will provide an overview of narcissism, including the AMPD formulation offered by DSM, relationship dynamics, developmental and etiological issues and the overlap between narcissism and substance use disorders. We will also review the overlaps and discrimination between narcissism and antisocial personality disorder/psychopathy. The various “types” of narcissism will be covered to better delineate the nuances of the personality style and how that may relate to addiction and substance use. Other dynamics such as shame, saving face, and validation seeking as part of the recovery process will also be addressed. Working with narcissistic clients who are managing co-occurring substance use remains a significant challenge for clinicians, and can raise a sense of helplessness, frustration, and other potentially problematic counter-transferential dynamics. Intersectional issues related to race, social class and economic status will also be addressed. Tips for maximizing clinician efficacy in working with this population will be addressed, as will the important of realistic expectations not only for the clinician but also for family and other stakeholders.
Learning Objectives:
At the conclusion of this activity, learners should be able to:
• Recite existing diagnostic definitions of narcissistic personality disorder, as well as conceptualizations of antagonism, the alternative model for personality in the DSM, and narcissism overall.
• Recognize “subtypes” of narcissistic presentations, particularly grandiose, vulnerable, malignant, and communal, and consideration of overt vs. covert grandiosity.
• Explain the relationship between narcissism and substance use/addiction including the role of dysregulation and impulsivity, and etiological issues.
• Apply knowledge of the assessment, management and treatment issues raised by narcissism into practice when treating patients with substance use disorders.
• Recognize barriers to treatment and management of substance use disorders raised by narcissism, and implement tools to optimize treatment of patients with substance use disorders.
