Written by Dr. Sanjana V.B Bhms,dbrm,cdn
Founder & medical director of siahmsr wellness.in

Reviewed by SIAHMSR

Homeopathic remedies for Narcissistic personality disorder (NPD)

 Narcissistic personality disorder (NPD) is a mental illness coming under personality disorder in which people have extreme self-importance and an inflated opinion of themselves. They crave for admiration from others for every single act done in life and are great attention seekers too.

The grave part of this disorder is that ungratified desires and lack of appreciation arouse extreme anger and aggressive behavior. It is classified under Cluster B personality disorders, with overly emotional and unpredictable behavior.

   People with this personality have extremely high self-esteem about themselves. They often behave arrogant, self -centered and demanding.

It often coexists with other mood [affective] and personality disorders. These people manifest hyper emotional and unpredictable behavior.

 NPD can cause problems in many areas of an individual’s life, including work, school, family and in relationships.

NPD appears to be more prevalent in the population [6.2%]. NPD shows male preponderance. Men are more affected with this personality disorder.

 Narcissistic personality disorder (NPD) is associated with sense of grandiosity, need for admiration, and lack of empathy.

Individuals with NPD may experience significant psychological distress related to interpersonal conflict.

  It is an interesting fact to know that people with this disorder often die due to cardiovascular diseases than those without personality disorders.

Clinical Presentation

·       A persistent pattern of self-glorification is a characteristic seen in these people and they feel constant need to highlight their exceptional skills or uniqueness. Display of own glory and self-importance is the predominant symptom of this disorder.

·        Feeling of extreme self- importance which needs gratification from others and if it is not received it may arouse anger and aggressive behavior.

·       Hyperemotional and oversensitive behavior to perceived insults from others.

     Contradiction or criticism offends and it is perceived in a negative perspective of humiliation or insult. Even trifles make him or her offended and irritated.

·        Unrealistic goal-setting is another characteristic and feeling of failure and low mood prevail in their life.

·       Their tolerance to distresses in life is very low.

     That means, there is irritability, difficulty to cope with distresses in life. The emotional response is poorly regulated and it is not in accordance with the traditionally accepted range of emotional reaction. It is often exaggerated.

·       There is marked fluctuation of mood. It is manifested as outburst of anger, anxiety, depression,

·       Suicidal thoughts are present in severe forms.

     They do self-harm and self-damaging behaviors are common.     

     Narcissistic personalities may have multiple other comorbidities coexisting like OCD, depression, anxiety etc.

·       Person with NPD is often arrogant, haughty and envious of others or believes that others are envious of them. Therefore NPD affects quality of life, social interactions and relationships.

·        People with this personality disorder may be vulnerable to extensive substance abuse [use of drugs] also.

Types of NPD

There are two basic subtypes of NPD, including grandiose and vulnerable narcissistic personality disorders.

1. The grandiose NPD includes overt grandiosity, presence of aggression, and boldness. Aggression, lack of empathy, and exploitation of others are chief characteristics. The level of aggression indicates the severity of the personality disorder.  These people often exaggerate achievements and expect to be recognized as superior without actually completing the tasks. There is a sense of entitlement, such as an unreasonable expectation of favorable treatment from others.

2.  The vulnerable NPD presents with over sensitivity and defensiveness and is often easy to miss the disorder in these people. This type is also called covert NPD.

These people are often introverted, insecure and cannot bear criticism. They have self-doubt and self-consciousness. But these types of NPD individuals also blame others, exploits others.

Extreme reaction to criticism or perceived criticism is the hallmark of NPD. They may have lower self-esteem and insecurity. Anxiety and depression may coexist in them.

The people with this personality disorder NPD often experience many other physical and mental health comorbidities and social problems such as anxiety & depression.

Causes

·  Genetic predisposition

·  Negative experiences of childhood. Neglect from parents.

·  Excessive pampering of children.

Diagnosis

  It requires evaluation of long-term patterns of functioning of the person. One needs to be cautious not to jump to hasty conclusions. Different aspects of a person's life and an understanding of the person's childhood development are necessary to diagnose the condition as NPD.

Treatment

Conventional treatment:

No standardized pharmacological or psychological treatment has been established for persons with narcissistic personality disorder. NPD is present, along with other mood disorders & need to be managed with medications; including anxiety, depression, mood lability, transient psychosis, and impulse control issues. Antidepressants, including selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, have been used.

Differential Diagnosis

·       Mood disorders

·       Anxiety

·       Depression

·       Antisocial  personality disorder

·       Histrionic  personality disorder

·       Borderline  personality disorder

·       Obsessive-compulsive disorder

·       Substance-induced mood disorder

NPD needs to be differentiated from all these disorders by history taking, evaluation and clinical psychological examinations.

Homeopathic treatment for  Narcissistic personality disorder

Homeopathic treatment for the personality disorder is based on assessment of individual constitution. Medicines are chosen based on this assessment and evaluation.

Medicines:

  Platina, sulphur ,veratrum album top the list if egotistical behaviour is presented as the major symptom as in grandiose NPD. Veratrum is used if manic episodes follow with aggressiveness.

  Narcissistic personalities may have multiple other comorbidities coexisting like OCD, depression, anxiety etc. and their occurrence vary from person to person.

 Medicines are selected based on the total manifestations and associated other mental illnesses .Individualization is important in medicine prescription.

   Another great hindrance in the treatment is that the individual’s struggle to form intimate relationships. It is a significant barrier to positive treatment outcome, due to the patient’s potential inability to form a safe and trusting relationship with the therapist. The researchers have found that individuals with NPD have higher rates of self-terminating treatment.

The constitutional treatment with deep acting medicines as therapeutic agents must be continued for a long time.

Regular observation and screening is necessary to understand the progress of treatment with respect to aggressiveness, emotional dysregulation, hypersensitivity etc.

·       Arsenicum album

It is indicated in people with fixed mindset, fastidiousness. Anxiety and depression may coexist in these people with NPD and arsenic album can be a good choice. Restless mind is another predominant symptom. Arsenic also shares feeling of anxiety and fear throughout their lives. Fear of solitude, death etc.

Arsenic is indicated in hypochondriacal people with fear of disease. NPD is also associated with lots of fears.

Censorious nature is prominent; overcritical people.

Oversensitivity of senses.

At another end, hopelessness and sadness can be noted in arsenic.

Many of the mental disturbances are associated with gastric disturbances. Burning sensation in stomach, dry lips, recurrent aphthae, stomach is upset that eating and drinking causes vomiting, prostration. Exertion such as motion causes fatigue. Melancholy; anguish at night.

Modalities < night, midnight after, cold

·       Carcinosin

It is often prescribed as a constitutional remedy for addressing the chronic miasm of cancer lurking in the background and manifest in various dimensions. Carcinosin  is often indicated for children and adults with family history of cancer, tuberculosis etc. 

Complaints in carcinosin arise from parental over control  and is associated with suppressed desires. Constant anxiety is a predominant feature in carcinosin which may lead to  a large number of other health problems.

Insomnia & gastric disturbances frequently affect the person during childhood. Gastrointestinal disturbances such as diarrhoea or constipation is constant. Child often sleeps in knee elbow position.

·        Sulphur  

Grandiosity is marked in Sulphur.

Complaints from suppressed eruptions. Sulphur is chosen as a similimum based on constitutional assessment, as an intercurrents or as a remedy after an acute prescription in people having NPD.

Ragged philosopher is the term used to describe Sulphur as such a person speculate more. S ulphur being a polychrest and deep acting remedy it is often prescribed after comprehensive analysis of the case.

·       Platina

Arrogance , haughtiness with self- importance dominate in platina.

The remedy is indicated more in females with menstrual problems and nymphomania and hypersensitivity. Melancholy depression of spirits.

Alteration of mental and physical symptoms common in platina; changing  moods. Sometimes platina can have a homicidal mind. Laughing and weeping can be alternate in these personalities. Irritability  and anger is prominent. Grandiosity. Feels that one is so big and huge and all others small. Superiority sense

High self esteem and self importantce with arrogance.

·       Natrum muriaticum

Self-obsession, irritability on least contradiction, criticism is intolerable. But unlike platina natrum mur has no haughtiness and superiority complex displayed or manifested. Vulnerable pattern of NPD is often addressed with Natrum mur which is affected by humiliation and wounded pride.

A constitution with greasy skin

Chronic constipation or diarrhoea.

·       Veratrum album

Melancholia or depression. Fainting from emotions, least exertion. Mania  .In anger and fury tears the person  tear clothing.it is associated withcursing, stamping etc. the person wants to run away, makes great noise.

      Other drugs indicated are ars alb, calcarea carb,carc,caust,bell, stram,tub,iodum,staphy,nat.m ,nat.c,Thuja etc.

The acute manifestations can be tackled with some short acting drugs for the time being. But the whole case needs a deeper comprehensive individualized approach from both clinical and Homeopathic point of view.

The acute episodes needs to be addressed as most often it is a psychiatric emergency presenting with mania ,over anxiety, depression major ,self-destructive behavior etc. The drug list cited above may be of some help in this regard.

written by Dr. Sanjana V.B BHMS DBRM CDN
Mental wellness consultant siahmsrwellness clinic
former consultant gandhi holistic hospital[homeopathic psychiatry]

References

1.     https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5819598/
2.     Materia Medica by James Tyler Kent
3.      Materia Medica by John Henry Clarke
4.      Pocket Manual Of Homoeopathic Materia Medica & Repertory
5.      A Concise Repertory Of Homeopathic Medicines
6.      Homoeopathic Medical Repertory
7.    The carcinosin drug picture- dr.D.m .Fobister
8.     SIAHMSR clinical archive data

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