The client is a 48-year-old successful businessman who is charming but lacks empathy. He uses and discards people without care. The client expects compliance without question and manipulates others for personal gain. He was convicted of insider trading but does not believe he has a problem. The therapist diagnoses the client with narcissistic personality disorder based on criteria such as grandiosity, entitlement, and lack of empathy.

1. case study presentationpsychology 672 – psychological dysfunctioneverett painter

2. client is a 48 year old married man with a successful career in the world of corporate finance. he lives in new york city with his wife and son. client is charming and has the ability to attract many associates. however, when a person is no longer of use to him, he discards them without care or feeling. in fact, he deems most people as being unworthy.

3. client is often seen drinking alcohol or smoking cigarettes, at all hours of the day, but reports that this is not an issue. his associates are known to engage in heavier drug use (i.e., cocaine).he is well known to be very difficult to work with, often expecting automatic compliance with his wishes without question. he has also been known to manipulate relationships for personal gain without remorse. he is prone to angry outbursts when things do not go his way.

4. client has attained a celebrity level of status and is well known throughout the city, and to a certain extent, on a global level as well. he possesses the finest suits, finest cars, and dines at the finest restaurants…and he makes certain that everyone knows it.

5. during supplemental interviews, a friend remarked that what troubled him most about the client, was that he is seemingly blind to the needs and feelings of others. other individuals noted that he has always been “self-centered” and “egotistical”. one person remarked that he talked about “family, work and life in general as if there was nobody else in the picture”. another commented that he “lives in his only little world”.

6. client is currently serving time in prison due to a conviction for insider training. his therapist notes little progress and indicates the client devalues and belittles him during sessions. client is resistant to all interventions and often questions the competence of the therapist. client does not believe that he has a problem and thinks he was wrongly convicted for his business practices.

7. final clue“greed is good.”

8. Michael Douglas as Gordon Gekko Wall Street (1987)Case Study PresentationPsychology 672 – Psychological DysfunctionEverett Painter

9. formal multiaxial diagnosisaxis i – 305.10 nicotine dependence 799.9 diagnosis deferred (alcohol abuse) V15.81 noncompliance with treatmentaxis ii – 301.81 narcissistic personality disorder (principle diagnosis)axis iii – noneaxis iv – problems related to interaction with the legal system (incarceration), occupational problem (other)axis v – gaf score = 50 (current)

10. dsm-iv-tr diagnostic criteria:narcissistic personality disorderA pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:(1) has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)(2) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love(3) believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)(4) requires excessive admiration

11. dsm-iv-tr diagnostic criteria:narcissistic personality disorder(5) has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations(6) is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends(7) lacks empathy: is unwilling to recognize or identify with the feelings and needs of others(8) is often envious of others or believes that others are envious of him or her(9) shows arrogant, haughty behaviors or attitudes

12. narcissistic personality disorder considerations(1) Narcissistic traits are common in adolescents.(2) 50-75% are men.(3) prevalence: 2-16% (clinical), less than 1% (general pop.)(4) differential diagnosis: histrionic, anti-social, and borderline personality disorders.(5) most useful distinguishing features include the presence of grandiosity, a somewhat stable self-image and the absence of self-destructiveness.(6) must also be distinguished from symptoms that can develop from chronic substance use.

13. narcissistic personality disorder etiologyunknown…possibilities include:- an oversensitive temperament at birth - overindulgence and overvaluation by parents - valued by parents as a means to regulate their own self-esteem - excessive admiration that is never balanced with realistic feedback - unpredictable or unreliable care giving from parents - severe emotional abuse in childhood - being praised for perceived exceptional looks or talents by adults - learning manipulative behaviors from parents (groopman & cooper)

14. wall street – select film scenes00:32:00 – “get a dog” scene – illustration: lack of empathy and feeling.01:17:00 – classic “greed is good” speech – illustration of a number of features including grandiosity.01:33:00 – victim realizes that he has been taken advantage of.01:36:00 – illustration: fantasy of unlimited power. 01:56:00 – illustration: need for excessive admiration.

15. referencesamerican psychiatric association. (2000). personality disorders. diagnostic and statistical manual of mental disorders: dsm-iv-tr (4th ed., pp 714-717). arlington. groopman, l. c. & cooper, a. m. narcissistic personality disorder. retrieved april 3, 2010, from armenian medical network website: http://www.health.am/psy/narcissistic-personality-disorder/pressman, e. (producer), & stone, o. (director). (1987). wall street [motion picture]. united states: 20th century fox.