1. Select one of the personality disorders from the DSM-5. a description of the personality disorder you selected. 3. Explain a therapeutic approach (including psychotropic medications if appropriate) you might use to treat a client presenting with this disorder, 4. including how you would share your diagnosis of this disorder to the client in order to avoid damaging the therapeutic relationship. Support your approach with evidence-based literature.
Personality disorders are a set of mental health conditions characterized by persistent patterns of thoughts, feelings, and behaviors that deviate from cultural and societal norms. These patterns typically appear during adolescence and continue throughout adulthood, causing significant distress and impairment in multiple areas of functioning. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides a comprehensive classification system for personality disorders, which helps clinicians in diagnosing and treating individuals suffering from these conditions.
One personality disorder that I have chosen to discuss is Narcissistic Personality Disorder (NPD). NPD is a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, which begins in early adulthood and is present in a variety of contexts. Individuals with NPD often have an exaggerated sense of self-importance and a preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love. They require excessive admiration, possess a sense of entitlement, and often exploit others to achieve their goals. They lack empathy and are unable to recognize or identify with the needs of others.
When treating a client with NPD, a therapeutic approach that combines psychotherapy and, in some cases, psychotropic medications can be beneficial. The primary therapeutic approach recommended for NPD is psychotherapy, specifically dialectical behavior therapy (DBT) and cognitive-behavioral therapy (CBT). These evidence-based treatments focus on helping individuals with NPD gain insight into their maladaptive patterns of thinking and behaving, as well as develop healthier coping mechanisms and interpersonal skills.
In DBT, the therapist aims to enhance the client’s motivation for change while also teaching them a variety of skills, such as emotion regulation, distress tolerance, mindfulness, and interpersonal effectiveness. DBT has shown promising results in improving emotional dysregulation and interpersonal difficulties commonly observed in individuals with NPD (Linehan, 2018). Through individual and group sessions, the therapist helps the client recognize their distorted thinking patterns, evaluate the consequences of their behaviors, and develop more adaptive ways of relating to others.
CBT, on the other hand, focuses on identifying and challenging the client’s maladaptive thoughts and beliefs that contribute to the development and maintenance of NPD symptoms. The therapist assists the client in developing alternative ways of thinking that are more realistic and adaptive. Additionally, CBT also emphasizes the development of problem-solving and assertiveness skills to help the client navigate relationships effectively (Reevy et al., 2018).
In some cases, psychotropic medications may be prescribed in conjunction with psychotherapy for individuals with NPD. The use of medications is mostly targeted at managing comorbid symptoms such as depression, anxiety, or impulsivity, rather than directly addressing NPD itself. Selective Serotonin Reuptake Inhibitors (SSRIs) or other antidepressants may be prescribed to alleviate symptoms of depression or anxiety, while mood stabilizers or antipsychotic medications may be used to manage impulsivity or aggression (Ronningstam et al., 2018). However, it is important to note that medications alone do not effectively treat NPD and should always be combined with psychotherapy for comprehensive management.
When sharing the diagnosis of NPD with the client, it is crucial to approach the conversation with sensitivity and empathy to avoid damaging the therapeutic relationship. The first step is to establish a trusting and supportive therapeutic alliance with the client, ensuring that they feel safe and comfortable discussing their thoughts and feelings. It is essential to explain the diagnosis in a clear, non-judgmental manner, emphasizing that NPD is a treatable condition and that the therapist is available to support the client in their journey towards recovery.