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Pathological narcissism is an addiction to Narcissistic Supply, the narcissist's drug of choice. It is, therefore, not surprising that other addictive and reckless behaviours – workaholism, alc

According to USFDA, a combination product is one composed of any combination of a drug and device; biological product and device; drug and biological product

oholism, drug abuse, pathological gambling, compulsory shopping, or reckless driving – piggyback on this primary dependence.

The narcissist – like other types of addicts – derives pleasure fro

; or drug, device, and biological product and fixed dose combination would include two or more combinations of drug.

Examples of combination products may in

m these exploits. But they also sustain and enhance his grandiose fantasies as "unique", "superior", "entitled", and "chosen". They place him above the laws and pressures of the mundane and awa

lude drug-coated devices, drugs packaged with delivery devices in medical kits, and drugs and devices packaged separately but intended to be used together.

y from the humiliating and sobering demands of reality. They render him the centre of attention – but also place him in "splendid isolation" from the madding and inferior crowd.

Such compulsor

here is enormous increase in the number of combination products entering the market in the recent years. Combination products have proven advantages but fixe

and wild pursuits provide a psychological exoskeleton. They are a substitute to quotidian existence. They afford the narcissist with an agenda, with timetables, goals, and faux achievements. T

d dose combinations are still in the process of convincing regulatory authority on their advantages over the single ingredient formulations.

Combination pro

he narcissist – the adrenaline junkie – feels that he is in control, alert, excited, and vital. He does not regard his condition as dependence. The narcissist firmly believes that he is in char

ucts have become life saving products for the pharmaceutical companies who doesn’t have many innovative molecules in their product pipeline and have been inc

ge of his addiction, that he can quit at will and on short notice.

The narcissist denies his cravings for fear of "losing face" and subverting the flawless, perfect, immaculate, and omnipotent

easingly used in the product life cycle management. Even the companies having product patents are trying to extend their product life cycle through the combi

image he projects. When caught red handed, the narcissist underestimates, rationalises, or intellectualises his addictive and reckless behaviours – converting them into an integral part of his

nation products and maximize the revenues. But the companies involved in this practice are overlooking that they are burdening the patients both economically

grandiose and fantastic False Self.

Thus, a drug abusing narcissist may claim to be conducting first hand research for the benefit of humanity – or that his substance abuse results in enhanced

and physically. They need to rightly judge the benefits of the combination products and they have to even look at the risks involved when combining the produ

creativity and productivity. The dependence of some narcissists becomes a way of life: busy corporate executives, race car drivers, or professional gamblers come to mind.

The narcissist's add

ts. Some of the combination products were well accepted by physicians while others suffered. Companies involved in development of combination products are fi

ictive behaviours take his mind off his inherent limitations, inevitable failures, painful and much-feared rejections, and the Grandiosity Gap – the abyss between the image he projects (the Fal

ding difficulty in defining their combination products and facing various challenges from selecting a combination to marketing it.

Following aspects would a

se Self) and the injurious truth. They relieve his anxiety and resolve the tension between his unrealistic expectations and inflated self-image – and his incommensurate achievements, position,

dd to the challenges in developing combination products:

Which markets to tap where the combination products can do fairly well?
Which combination prod

tatus, recognition, intelligence, wealth, and physique.

Thus, there is no point in treating the dependence and recklessness of the narcissist without first treating the underlying personality

cts are meaningful and rational?
Which therapeutic categories to select?
Which Combinations can address unmet needs of the patients?
Do combin

disorder. The narcissist's addictions serve deeply ingrained emotional needs. They intermesh seamlessly with the pathological structure of his disorganised personality, with his character fault

tions increase the patient compliance?
What would be the developing cost?
How to tackle the risks encountered during combination product developmen

s, and primitive defence mechanisms.

Techniques such as "12 steps" may prove more efficacious in treating the narcissist's grandiosity, rigidity, sense of entitlement, exploitativeness, and la

t?

As combination products don't fit into the traditional categories of drugs, medical devices, or biological products, the USFDA is in the process of devel

ck of empathy. This is because – as opposed to traditional treatment modalities – the emphasis is on tackling the narcissist's psychological makeup, rather than on behaviour modification.

The

ping new procedures for reviewing their safety, efficacy and quality.

Professional from academic institutions, pharmaceutical industries, health care indust

arcissist's overwhelming need to feel omnipotent and superior can be co-opted in the therapeutic process. Overcoming an addictive behaviour can be – truthfully – presented by the therapist as a

y and representatives from various regulatory agencies are working out to design the regulatory requirements for manufacture and sale of combination products

rare and impressive feat, worthy of the narcissist's unique mettle.

Narcissists fall for these transparent pitches surprisingly often. But this approach can backfire. Should the narcissist re

.

As there is an increasing trend of the combination products companies manufacturing such products should be able to tackle the problems involved in the de

lapse – an almost certain occurrence – he will feel ashamed to admit his fallibility, need for emotional sustenance, and impotence. He is likely to avoid treatment altogether and convince himse

elopment. They need to be wiser in analyzing the market trends and the regulatory requirements.

Companies that provide selfless information through particip

lf that now, having succeeded once to get rid of his addiction, he is self-sufficient and omniscient.

First published in my
"Narcissistic Personality Disorder"
Topic Page on Suite 10

tion in industry events and feedback to regulatory authorities would be able to face the challenges and will be successful in developing combination products

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