Do narcissists also suffer from eating disorders such as bulimia nervosa or anorexia nervosa?

Answer:

Patients suffering from eating disorders either binge on food or refrain from eating and sometimes are both anorectic and bulimic. This is an impulsive behaviour as defined by DSM and is sometimes comorbid with Cluster B personality disorder, particularly with Borderline Personality Disorder.

Some patients develop eating disorders as convergence and confluence of two pathological behaviours: self-mutilation and an impulsive (rather, obsessive-compulsive or ritualistic) behaviour.

The key to improving mental state of patients who have been diagnosed with both a personality disorder and an eating disorder lies in focusing at first upon their eating and sleeping disorders.

By controlling his eating disorder, patient reasserts control over his life. This newfound power is bound to reduce depression, or even eliminate it altogether as a constant feature of his mental life. It is also likely to ameliorate other facets of his personality disorder.

It is a chain reaction: controlling one's eating disorders leads to a better regulation of one's sense of self-worth, self-confidence, and self-esteem. Successfully coping with one challenge - eating disorder - generates a feeling of inner strength and results in better social functioning and an enhanced sense of well-being.

When a patient has a personality disorder and an eating disorder, therapist would do well to first tackle eating disorder. Personality disorders are intricate and intractable. They are rarely curable (though certain aspects, like obsessive-compulsive behaviours, or depression can be ameliorated with medication or modified). The treatment of personality disorders requires enormous, persistent and continuous investment of resources of every kind by everyone involved.

From patient's point of view, treatment of her personality disorder is not an efficient allocation of scarce mental resources. Neither are personality disorders real threat. If one's personality disorder is cured but one's eating disorders are left untouched, one might die (though mentally healthy)…

An eating disorder is both a signal of distress ("I wish to die, I feel so bad, somebody help me") and a message: "I think I lost control. I am very afraid of losing control. I will control my food intake and discharge. This way I can control at least ONE aspect of my life."

This is where we can and should begin to help patient - by letting her regain control of her life. The family or other supporting figures must think what they can do to make patient feel that she is in control, that she is managing things her own way, that she is contributing, has her own schedules, her own agenda, and that she, her needs, preferences, and choices matter.

"(People with personality disorders) ... cause resentment and possibly even alienation and burnout in healthcare professionals who treat them ... (p. 318) Long-term psychoanalytic psychotherapy and psychoanalysis have been attempted with (narcissists), although their use has been controversial."

The reason narcissism is under-reported and healing over-stated is that therapists are being fooled by smart narcissists. Most narcissists are expert manipulators and consummate actors and they learn how to deceive their therapists.

Here are some hard facts:

There are gradations and shades of narcissism. The differences between two narcissists can be great. The existence of grandiosity and empathy or lack thereof are not minor variations. They are serious predictors of future psychodynamics. The prognosis is much better if they do exist. There are cases of spontaneous healing, Acquired Situational Narcissism, and of "short-term NPD" [see Gunderson's and Ronningstam work, 1996]. The prognosis for a classical narcissist (grandiosity, lack of empathy and all) is decidedly not good as far as long-term, lasting, and complete healing. Moreover, narcissists are intensely disliked by therapists. BUT…

Side effects, co-morbid disorders (such as Obsessive-Compulsive behaviors) and some aspects of NPD (the dysphorias, persecutory delusions, sense of entitlement, pathological lying) can be modified (using talk therapy and, depending on problem, medication). These are not long-term or complete solutions – but some of them do have long-term effects. The DSM is a billing and administration oriented diagnostic tool. It is intended to "tidy" up psychiatrist's desk. The Axis II Personality Disorders are ill demarcated. The differential diagnoses are vaguely defined. There are some cultural biases and judgements [see diagnostic criteria of Schizotypal and Antisocial PDs]. The result is sizeable confusion and multiple diagnoses ("co-morbidity"). NPD was introduced to DSM in 1980 [DSM-III]. There isn't enough research to substantiate any view or hypothesis about NPD. Future DSM editions may abolish it altogether within framework of a cluster or a single "personality disorder" category. When we ask: "Can NPD be healed?" we need to realise that we don't know for sure what is NPD and what constitutes long-term healing in case of an NPD. There are those who seriously claim that NPD is a cultural disease (culture-bound) with a societal determinant. Narcissists in Therapy

In therapy, general idea is to create conditions for True Self to resume its growth: safety, predictability, justice, love and acceptance - a mirroring, re-aprenting, and holding environment. Therapy is supposed to provide these conditions of nurturance and guidance (through transference, cognitive re-labelling or other methods). The narcissist must learn that his past experiences are not laws of nature, that not all adults are abusive, that relationships can be nurturing and supportive.

Most therapists try to co-opt narcissist's inflated ego (False Self) and defences. They compliment narcissist, challenging him to prove his omnipotence by overcoming his disorder. They appeal to his quest for perfection, brilliance, and eternal love - and his paranoid tendencies - in an attempt to get rid of counterproductive, self-defeating, and dysfunctional behaviour patterns.