Alex, 29, begins therapy because he feels like his life is falling apart and nothing is going the way he wants. Everyone just seems to have it out for him lately. In the first few sessions, he complains of an inability to tolerate other people’s stupidity. He frequently struggles with feelings of emptiness and dissatisfaction, attributing these emotions to being unappreciated. This has led to depressive symptoms.
At his job, Alex has experienced a few problems. Any minor setbacks or criticism from his boss will lead to intense feelings of humiliation and the belief that he is being wronged. However, he claims his coworkers are simply jealous that he's better than them. He insists others just can’t handle his brutal honesty and says if he were in charge, everything would run smoother.
A deeper look shows that Alex is preoccupied with how others view him. If he doesn’t feel acknowledged on a regular basis, he then becomes irritable and isolates himself. Being vulnerable is difficult for Alex, any need for emotional support is considered a display of weakness. Similarly, his relationships are marked by a lack of emotional intimacy. He has some acquaintances but states that no one really knows him. When it comes to his partners, Alex has a hard time seeing their needs, feelings, or struggles as equally important.
Alex meets the diagnostic criteria for Narcissistic Personality Disorder.