Narcissistic patients

The patient with histrionic personality disorder (HPD) craves attention from others and resorts to excessive displays of emotion to obtain it. Like the narcissistic patient, the histrionic demands to be the center of attention but typically without the haughty arrogance of the narcissist. They are also manipulative and easily frustrated like the antisocial patient but able to experience remorse and are generally more law abiding. Finally, the histrionic patient experiences mood instability much like the borderline patient but is typically not as severely impaired. Whereas the borderline patient is frequently self-destructive and feels chronically empty, the histrionic patient is usually not prone to these more severe disturbances. 

The never-ending search for the perfect relationship, the perfect job, and the perfect life that narcissistic patients pursue may extend to the demand for the perfect medication—which pharmaceutical companies have not as yet developed. 

Clnster B includes the so-called dramatic and emotional disorders. This group is comprised of antisocial personality disorder (ASPD), borderline personality disorder (BPD), narcissistic personality disorder (NPD), and histrionic personality disorder (HPD). In each of these disorders, the person is attention seeking, is emotionally unstable, and finds it difhcnlt to conform to social norms. Unlike the odd and eccentric Cluster A patients and the anxious and withdrawn Cluster C patients, those with Cluster B personality disorders seldom escape clinical attention for very long. The disruptive nature of these personality disorders often leads them to psychiatric or legal intervention no later than their early adult life. 

Despite overlapping symptoms in the Clnster B personality disorders, there are key distingnishing characteristics of each. Antisocial personality disorder (ASPD) is characterized by a patient s lack of concern for and repeated victimization of others. For this reason, the popnlar terms sociopath and psychopath have been applied to those with an antisocial personality. This indifference toward the feelings of others can also be seen in those with a narcissistic personality, bnt in that case it serves to feed the narcissist s need for admiration. The antisocial patient instead nses others as a means to gain some material or hnancial beneht. Of course, there are patients who fnlhll the diagnostic criteria for both narcissistic and antisocial personality disorders. 

Narcissistic Personaiity Disorder (NPD). Medications have not been studied to any extent in the treatment of NPD. In our experience, antidepressants are often used to treat these patients, but more so for the common comorbid depression than for the personality disorder itself. It is not clear to what extent, if any, medications may be helpful in treating the target symptoms of NPD itself. 

The medical records of ten patients with a DSM-IV diagnosis of cluster B personality disorder (narcissistic personality disorder) who had taken olanzapine 2.5-20 mg/day for 8 weeks have been reviewed (876). The mean Social Dysfunction and Aggression Scale score was 29 for the 8 weeks before olanzapine therapy and improved to 14 after 8 weeks of treatment. Five of the ten patients developed severe weight gain. 

Borderline disorders have been viewed both from a behavioral-symptomatic perspective (such as that of DSM-IV) and a theoretical perspective (for example, borderline personality organization a la Kemberg and others). As Grinker and many subsequent researchers and clinicians agree, borderline patients are not all alike they present in many different sizes and shapes. You can see borderline characteristics in the context of a number of different personality styles schizoid-detached, obsessional, paranoid, narcissistic, and histrionic. However, all varieties share a few common characteristics ... 

Ronningstam, E. and Gunderson, J. (1988). Narcissistic traits in psychiatric patients. Comprehensive Psychiatry 29 545-9. 

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