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Klein JP, Schaich A, Furukawa TA. How should narcissism be treated best? Lancet Psychiatry 2023; 10:914-916. [PMID: 37844593 DOI: 10.1016/s2215-0366(23)00307-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Jan Philipp Klein
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Lübeck University, Lübeck 23538, Germany; Center for Brain, Behavior, and Metabolism, Lübeck University, Lübeck, Germany.
| | - Anja Schaich
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Lübeck University, Lübeck 23538, Germany; Department of Psychiatry, Psychosomatics and Psychotherapy, Kiel University, Kiel, Germany
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
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Discrepancy of the subjective perception of the nasal appearance between independent individuals and patients undergoing functional rhinoplasty (fRPL). Eur Arch Otorhinolaryngol 2023; 280:191-197. [PMID: 35763081 PMCID: PMC9813204 DOI: 10.1007/s00405-022-07504-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/09/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE Satisfaction with the nasal appearance is a crucial outcome parameter in functional rhinoplasty (fRPL). The visual analogue scale is a suitable instrument not only for the preoperative patient assessment, but also as a patient-reported outcome measure in fRPL. In this study, we analyzed whether a high discrepancy in the preoperative subjective perception of the nasal appearance between patients and other individuals predicts a lower level of satisfaction with the postoperative result and hence a worse outcome of fRPL. METHODS Standardized facial pictures of patients (n = 80) who underwent fRPL were taken preoperatively, 3 and 12 months postoperatively. In addition, patients were asked to complete the German version of the Utrecht Outcome Assessment Questionnaire in Aesthetic Rhinoplasty (D-OAR). The standardized facial pictures of the patients were presented to surgeons as well as to examiners without a medical background, and they were asked to evaluate the patients' nasal appearance using the visual analogue scale. RESULTS The external evaluation of patient's nasal appearance was 1.7 points higher in median than the patient's subjective perception (range -5.7-7.00). A large discrepancy between self- and external estimation significantly correlates with higher D-OAR values (r = 0.539, p < 0.001). Patients with high scores in the D-OAR trick questions, indicating a body dysmorphic disorder, show a significant larger discrepancy between the external- and the self-assessment (2.8 ± 0.5 vs. 1.4 ± 0.3, mean ± SEM, p = 0.017). CONCLUSIONS Large discrepancies between the self and external assessment of the nasal appearance are associated with a high-perceived influence of the appearance of the nose on the quality of life in patients undergoing functional rhinoplasty. That might be an indicator for unrealistic expectations concerning the postoperative outcome. Knowledge about this factor helps to identify the need for intensive discussion about possibilities and limitations of the planned procedure to avoid postoperative dissatisfaction.
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Stolz DS, Vater A, Schott BH, Roepke S, Paulus FM, Krach S. Reduced frontal cortical tracking of conflict between self-beneficial versus prosocial motives in Narcissistic Personality Disorder. NEUROIMAGE-CLINICAL 2021; 32:102800. [PMID: 34461435 PMCID: PMC8405953 DOI: 10.1016/j.nicl.2021.102800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/15/2022]
Abstract
Narcissistic Personality Disorder (NPD) entails severe impairments in interpersonal functioning that are likely driven by self-beneficial and exploitative behavior. Here, we investigate the underlying motivational and neural mechanisms of prosocial decision-making by experimentally manipulating motivational conflict between self-beneficial and prosocial incentives. One group of patients diagnosed with NPD and a group of healthy controls (CTL) were scanned using functional magnetic resonance imaging while performing a prosocial decision-making task. In this task, we systematically varied the level of conflict between self-beneficial and prosocial options on each trial. We analyzed choice behavior, response times, and neural activity in regions associated with conflict monitoring to test how motivational conflict drives prosocial choice behavior. Participants in the NPD group behaved less prosocially than the CTL group overall. Varying degrees of motivational conflict between self-beneficial and prosocial options induced response variability in both groups, but more so in the CTL group. The NPD group responded faster than the CTL group, unless choosing prosocially, which slowed response times to a level comparable to the CTL group. Additionally, neural activity tracking motivational conflict in dorsomedial prefrontal cortex was reduced in the NPD group. Collectively, low generosity in NPD appears to arise from reduced consideration of prosocial motives, which obviates motivational conflict with self-beneficial motives and entails reduced activity in neural conflict monitoring systems. Yet, our data also indicate that NPD is not marked by an absolute indifference to others' needs. This points to potentials for improving interpersonal relationships, effectively supporting the well-being of patients and their peers.
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Affiliation(s)
- David S Stolz
- Social Neuroscience Lab, Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | - Aline Vater
- Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Björn H Schott
- Leibniz Institute for Neurobiology Magdeburg, Brenneckestraße 6, 39118 Magdeburg, Germany; Department of Psychiatry, University Medicine Göttingen, Von-Siebold-Str. 5, 37075 Göttingen, Germany
| | - Stefan Roepke
- Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Frieder M Paulus
- Social Neuroscience Lab, Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Sören Krach
- Social Neuroscience Lab, Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
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Jauk E, Kanske P. Can neuroscience help to understand narcissism? A systematic review of an emerging field. PERSONALITY NEUROSCIENCE 2021; 4:e3. [PMID: 34124536 PMCID: PMC8170532 DOI: 10.1017/pen.2021.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 03/23/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022]
Abstract
Narcissism is a Janusian personality construct, associated with both grandiose self-assuredness and dominance, as well as vulnerable insecurity and reactivity. Central questions of intra- and interpersonal functioning in narcissism are still a matter of debate. Neuroscience could help to understand the paradoxical patterns of experience and behavior beyond the limitations of self-reports. We provide a systematic review of 34 neuroscience studies on grandiose, vulnerable, pathological narcissism, and Narcissistic Personality Disorder (NPD), spanning experimental investigations of intra- and interpersonal mechanisms, research on neurophysiological and neuroendocrine aspects of baseline function, and brain structural correlates. While neuroscience has scarcely directly studied vulnerable narcissism, grandiose narcissism is associated with heightened vigilance to ego threat and stress responses following ego threat, as well as heightened stress indicators in baseline measures. Such responses are not commonly observed in self-reports, highlighting the potential of neuroscience to augment our understanding of self-regulatory dynamics in narcissism. Interpersonal functioning is characterized by deficits in social-affective processes. Both involve altered activity within the salience network, pointing to a double dissociation regarding the expression of narcissism and self/other oriented situational focus. Findings are summarized in an integrative model providing testable hypotheses for future research along with methodological recommendations.
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Affiliation(s)
- Emanuel Jauk
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
- Department of Psychology, University of Graz, Graz, Austria
| | - Philipp Kanske
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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Scrandis DA. Narcissistic personality disorder: Challenges and therapeutic alliance in primary care. Nurse Pract 2020; 45:13-15. [PMID: 32332228 DOI: 10.1097/01.npr.0000653968.96547.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Debra A Scrandis
- Debra A. Scrandis is an associate professor at the University of Maryland School of Nursing, Baltimore, Md
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Mota S, Leckelt M, Geukes K, Nestler S, Humberg S, Schröder-Abé M, Schmukle SC, Back MD. A Comprehensive Examination of Narcissists’ Self-Perceived and Actual Socioemotional Cognition Ability. COLLABRA-PSYCHOLOGY 2019. [DOI: 10.1525/collabra.174] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Narcissists are assumed to lack the motivation and ability to share and understand the mental states of others. Prior empirical research, however, has yielded inconclusive findings and has differed with respect to the specific aspects of narcissism and socioemotional cognition that have been examined. Here, we propose a differentiated facet approach that can be applied across research traditions and that distinguishes between facets of narcissism (agentic vs. antagonistic) on the one hand, and facets of socioemotional cognition ability (SECA; self-perceived vs. actual) on the other. Using five nonclinical samples in two studies (total N = 602), we investigated the effect of facets of grandiose narcissism on aspects of socioemotional cognition across measures of affective and cognitive empathy, Theory of Mind, and emotional intelligence, while also controlling for general reasoning ability. Across both studies, agentic facets of narcissism were found to be positively related to perceived SECA, whereas antagonistic facets of narcissism were found to be negatively related to perceived SECA. However, both narcissism facets were negatively related to actual SECA. Exploratory condition-based regression analyses further showed that agentic narcissists had a higher directed discrepancy between perceived and actual SECA: They self-enhanced their socio-emotional capacities. Implications of these results for the multifaceted theoretical understanding of the narcissism-SECA link are discussed.
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di Giacomo E, Colmegna F, Pescatore F, Aspesi F, Fotiadou M, Clerici M. The burden of personality disorders on the DSM 5 addiction to tobacco during pregnancy. Compr Psychiatry 2018; 84:101-105. [PMID: 29729554 DOI: 10.1016/j.comppsych.2018.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Tobacco smoking is a major health concern. Many women smoke during their reproductive years, some of them during their pregnancy. Adverse outcomes for the newborns physical health are well recognized, while the influence on their mental health is still under investigation. We aim at demonstrating the contribution of maternal personality disorders in maintaining addiction to tobacco during pregnancy, to underline their role and the need of their detection as a preventive effort. METHOD 150 women, consecutively admitted to the Perinatal Psychiatric Outpatient Department were tested with the SCID II, CTQ, WHOQOL-BREF, EPDS, BDI and BAI. Tobacco use disorder was attested with the fulfillment of DSM 5 criteria. RESULTS 46% (n = 69) of the sample was affected by at least one personality disorder ("PD+"). "PD+" showed a significant higher rate of pregnant women addicted to tobacco (p = 0.021). The average number of cigarettes per day was notably distinct, since patients affected by "NPD" smokes twice the amount compared to "PD-" and "other PDs", while those affected by Borderline PD has a halfway consumption (7.20 ± 5.54 vs 3.37 ± 4.62 vs 3 ± 3.39 vs 5.50 ± 4.10). ANOVA and POST HOC showed a significance between "NPD" and "other PDs" (p = 0.035), and "other PDs" has significantly the highest rate of active smokers. CONCLUSION Personality disorders demonstrate to be a clear contributor in supporting addiction to tobacco during pregnancy. Short and long term health and mental consequences attested in the newborn, encourage awareness in detecting tobacco dependency during this sensitive period. The inclusion of personality evaluation and management in tobacco dependency treatment programs is strictly encouraged to boost their efficiency and increase tobacco abstinence.
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Affiliation(s)
- Ester di Giacomo
- PhD program in Neuroscience, Doctorate School of the University of Milano-Bicocca, Italy; School of Medicine and Surgery-University of Milano Bicocca, Italy; Psychiatric Department-ASST Monza, Italy.
| | | | | | | | - Maria Fotiadou
- Female Medium Secure Forensic Service, South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Massimo Clerici
- School of Medicine and Surgery-University of Milano Bicocca, Italy; Psychiatric Department-ASST Monza, Italy
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Kramer U, Pascual-Leone A, Rohde KB, Sachse R. The role of shame and self-compassion in psychotherapy for narcissistic personality disorder: An exploratory study. Clin Psychol Psychother 2017; 25:272-282. [PMID: 29265698 DOI: 10.1002/cpp.2160] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 12/24/2022]
Abstract
This process-outcome study aims at exploring the role of shame, self-compassion, and specific therapeutic interventions in psychotherapy for patients with narcissistic personality disorder (NPD). This exploratory study included a total of N = 17 patients with NPD undergoing long-term clarification-oriented psychotherapy. Their mean age was 39 years, and 10 were male. On average, treatments were 64 sessions long (range between 45 and 99). Sessions 25 and 36 were rated using the Classification of Affective Meaning States and the Process-Content-Relationship Scale. Outcome was assessed using the Symptom Check List-90 and Beck Depression Inventory-II. Between Sessions 25 and 36, a small decrease in the frequency of shame was found (d = .30). In Session 36, the presence of self-compassion was linked with a set of specific therapist interventions (process-guidance and treatment of behaviour-underlying assumptions; 51% of variance explained and adjusted). This study points to the possible central role of shame in the therapeutic process of patients with NPD. Hypothetically, one way of resolving shame is, for the patient, to access underlying self-compassion.
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Affiliation(s)
- Ueli Kramer
- Institute of Psychotherapy and General Psychiatry Services, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Department of Psychology, University of Windsor, Windsor, ON, Canada
| | | | - Kristina B Rohde
- Bern University Hospital and University of Bern, Bern, Switzerland
| | - Rainer Sachse
- Institute for Psychological Psychotherapy, Bochum, Germany
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Jaksic N, Marcinko D, Skocic Hanzek M, Rebernjak B, Ogrodniczuk JS. Experience of Shame Mediates the Relationship Between Pathological Narcissism and Suicidal Ideation in Psychiatric Outpatients. J Clin Psychol 2017; 73:1670-1681. [DOI: 10.1002/jclp.22472] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 12/27/2016] [Accepted: 02/07/2017] [Indexed: 11/08/2022]
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Abstract
PURPOSE OF REVIEW This review summarizes recent executive functions research to better delineate the nosology of personality disorders. RECENT FINDINGS This review indicates that there are consistent impairments in executive functioning in people with personality disorders as compared with matched controls. Only five disorders were considered: borderline, obsessive-compulsive, antisocial, narcissistic, and schizotypal. Significant deficits are observed in decision-making, working memory, inhibition, and flexibility. Relevant data for the remaining personality disorders have not yet been published in relation to the executive functions. SUMMARY People with personality disorders could present a pattern of neurocognitive alterations that suggest a specific impairment of the prefrontal areas. The executive dysfunctions could partially explain the behavioral alterations in people with personality disorders.Further research should adopt broader considerations of effects of comorbidity and clinical heterogeneity, include community samples and, possibly, longitudinal designs with samples of youth.
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Marissen MAE, Brouwer ME, Hiemstra AMF, Deen ML, Franken IHA. A masked negative self-esteem? Implicit and explicit self-esteem in patients with Narcissistic Personality Disorder. Psychiatry Res 2016; 242:28-33. [PMID: 27254651 DOI: 10.1016/j.psychres.2016.04.070] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 01/22/2016] [Accepted: 04/21/2016] [Indexed: 11/28/2022]
Abstract
The mask model of narcissism states that the narcissistic traits of patients with NPD are the result of a compensatory reaction to underlying ego fragility. This model assumes that high explicit self-esteem masks low implicit self-esteem. However, research on narcissism has predominantly focused on non-clinical participants and data derived from patients diagnosed with Narcissistic Personality Disorder (NPD) remain scarce. Therefore, the goal of the present study was to test the mask model hypothesis of narcissism among patients with NPD. Male patients with NPD were compared to patients with other PD's and healthy participants on implicit and explicit self-esteem. NPD patients did not differ in levels of explicit and implicit self-esteem compared to both the psychiatric and the healthy control group. Overall, the current study found no evidence in support of the mask model of narcissism among a clinical group. This implicates that it might not be relevant for clinicians to focus treatment of NPD on an underlying negative self-esteem.
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Affiliation(s)
- Marlies A E Marissen
- Parnassia Group, PsyQ, Center for Personality disorders, The Hague, The Netherlands; Erasmus University Rotterdam, Institute of Psychology, Rotterdam, The Netherlands.
| | - Marlies E Brouwer
- Utrecht University, Clinical and Health Psychology, Utrecht, The Netherlands
| | | | - Mathijs L Deen
- Leiden University, Institute of Psychology, Methodology and Statistics Unit, Leiden, The Netherlands
| | - Ingmar H A Franken
- Erasmus University Rotterdam, Institute of Psychology, Rotterdam, The Netherlands
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Ronningstam E. Pathological Narcissism and Narcissistic Personality Disorder: Recent Research and Clinical Implications. Curr Behav Neurosci Rep 2016. [DOI: 10.1007/s40473-016-0060-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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