The hospitalization of patients with severe Narcissistic Personality may occur with some frequency. For some, such as those who are quite impulsive or self-destructive, or who have poor reality-testing, this is the result of additional symptoms from a co-existing mental disorder that are overlaid on the personality disorder. In general, hospitalizations should be brief and the treatment specific to the particular symptom involved.
Another group of patients for whom hospitalization is indicated, provided long-term residential treatment is available, are those who have poor motivation for outpatient treatment, fragile object or social relationships, chronic destructive acting-out behaviors, and/or chaotic life-styles. An inpatient program can offer an intensive milieu which includes individual psychotherapy, family involvement, and a specialized residential environment. The structure is physically and emotionally secure enough to sustain the patient with severe ego weakness throughout the course of expressive, conflict-solving psychotherapy.
Small staff/patient groups within the wards, as well as large community meetings, at which feelings are shared and patients’ comments taken seriously by staff, and constructive work assignments, recreational activities, and opportunities to sublimate painfully conflictual impulses make the hospital a “holding” environment rather than merely a containing one. The ultimate goals are of effecting a better integrated internal world, more cohesive and modulated self-object representation, and a self-concept less vulnerable to narcissistic injury.