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Green A, Day NJS, Hart CM, Grenyer BFS, Bach B. Gender bias in assessing narcissistic personality: Exploring the utility of the ICD-11 dimensional model. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024. [PMID: 39262046 DOI: 10.1111/bjc.12503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 08/27/2024] [Indexed: 09/13/2024]
Abstract
OBJECTIVES Narcissistic personality disorder as captured in categorical diagnostic systems (e.g., DSM-5) emphasizes grandiose features more associated with masculine norms and under-emphasizes vulnerable features more associated with femininity. This poses significant implications in diagnostic outcome and clinical treatment in women with narcissistic preoccupations. Research finds that clinicians using the DSM-5 categorical system tend to diagnose vulnerable narcissism in women as other 'feminized' personality disorders (e.g., borderline), but no research has explored gender differences in narcissism using the new ICD-11 dimensional framework for personality disorders. This study investigated the clinical utility of the ICD-11 approach in capturing gender differences in narcissistic presentations. METHODS Adopting an online vignette-based study, mental health clinicians (N = 157; 71.3% female) completed ratings of ICD-11 personality disorder severity and trait domains for two cases reflecting 'grandiose' and 'vulnerable' narcissism in hypothetical male or female patients. RESULTS The results showed that ratings of core impairments in personality functioning and overall severity were consistent irrespective of patient or clinician gender, contrasting prior research using categorical models. CONCLUSION While some differences were observed in trait domain (e.g., negative affectivity) between patient gender, these results suggest the clinical utility of the ICD-11 model as emphasizing elements of personality functioning in the process of assessment and diagnosis, therefore potentially being less susceptible to influences of gender stereotype in aiding clinical conceptualization.
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Affiliation(s)
- A Green
- Department of Psychology, City University of London, London, UK
| | - N J S Day
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - C M Hart
- Department of Psychology, University of Southampton, Southampton, UK
| | - B F S Grenyer
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - B Bach
- Psychiatric Research Unit, Center for Personality Disorder Research, Mental Health Services, Region Zealand, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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2
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Weinberg I, Ronningstam E, Ravichandran C, Gunderson JG. Can Patients With Narcissistic Personality Disorder Change? A Case Series. J Nerv Ment Dis 2024; 212:392-397. [PMID: 38949659 DOI: 10.1097/nmd.0000000000001777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
ABSTRACT The study was set out to establish the potential for psychotherapy to effect improvements in patients with narcissistic personality disorder (NPD). Eight patients with NPD who improved in treatment were identified. Consensus clinician/investigator diagnostic scores from before and after the psychotherapies were retroactively established on the Diagnostic Interview for Narcissism (DIN) and the Diagnostic Statistic Manual for Psychiatric Disorders, 5th Edition (DSM-5) Personality Disorder Section II criteria. Psychosocial functioning (work or school, romantic relationships) before and after the psychotherapies was retroactively evaluated as well. At the completion of the therapies after 2.5 to 5 years, all patients had improved, no longer met DIN or DSM-5 criteria for NPD, and showed better psychosocial functioning. Symptomatic improvements were associated with large effect sizes. In conclusion, changes in NPD can occur in treatment after 2.5 to 5 years. Future research should identify patient characteristics, interventions, and common processes in such improved cases that could help with development of treatments.
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Affiliation(s)
- Igor Weinberg
- McLean Hospital, Belmont, Massachusetts; and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Solka JR, Finan LJ. Narcissism and alcohol use: The mediating role of drinking motives among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-8. [PMID: 38917364 DOI: 10.1080/07448481.2024.2368000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 06/09/2024] [Indexed: 06/27/2024]
Abstract
Objective: The current study examined associations between grandiose and vulnerable subclinical narcissistic traits and alcohol use among college students and whether drinking motives mediated these associations. Methods and Participants: Young adult college students who reported past month alcohol use were invited to complete self-report online surveys (N = 406; 81% female; Mage = 20.13, SD = 1.69; 10% Hispanic; 85% White). Results: Results from path analysis using structural equation modeling indicated that there were no direct associations between grandiose or vulnerable subclinical narcissistic traits and alcohol use. However, several drinking motives mediated these associations. Specifically, the association between grandiose traits and alcohol use was mediated by enhancement and social motives. Similarly, the association between vulnerable traits and alcohol use was mediated by enhancement, social and coping motives. Conclusions: Findings highlight a potential mechanism by which personality traits may contribute to a health risk behavior among young people.
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Affiliation(s)
- Jake R Solka
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Laura J Finan
- Department of Psychology, Illinois State University, Normal, Illinois, USA
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4
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Bird J, Caligor E. A case report of the treatment of narcissistic personality disorder with transference focused psychotherapy. J Clin Psychol 2024; 80:1177-1191. [PMID: 38170437 DOI: 10.1002/jclp.23637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/30/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
The following case study provides a description of the transference-focused psychotherapy (TFP) treatment of a young man diagnosed with narcissistic personality disorder (NPD). TFP is an individual, psychodynamic therapy developed to treat a range of personality disorders. TFP is evidence-based for the treatment of borderline personality disorder and has been adapted for the treatment of NPD. This case illustrates the application of the strategies and techniques of TFP to treatment of NPD as well as challenges clinicians may face in arriving at timely diagnosis of the disorder. Although no specific treatment for NPD has been empirically validated, TFP utilizes the therapeutic techniques identified across modalities for successful treatment of pathological narcissism. This report describes how treatment interventions such as goal setting, developing a therapeutic alliance, using a treatment contract and addressing treatment interfering behaviors contributed to this patient's improvement in self-reflection, formation of healthier and more flexible ideas about self and other, increased self-agency, tolerance of normative disillusionments and increase in empathy.
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Affiliation(s)
- Joanna Bird
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Eve Caligor
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Price GD, Heinz MV, Song SH, Nemesure MD, Jacobson NC. Using digital phenotyping to capture depression symptom variability: detecting naturalistic variability in depression symptoms across one year using passively collected wearable movement and sleep data. Transl Psychiatry 2023; 13:381. [PMID: 38071317 PMCID: PMC10710399 DOI: 10.1038/s41398-023-02669-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/02/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
Major Depressive Disorder (MDD) presents considerable challenges to diagnosis and management due to symptom variability across time. Only recent work has highlighted the clinical implications for interrogating depression symptom variability. Thus, the present work investigates how sociodemographic, comorbidity, movement, and sleep data is associated with long-term depression symptom variability. Participant information included (N = 939) baseline sociodemographic and comorbidity data, longitudinal, passively collected wearable data, and Patient Health Questionnaire-9 (PHQ-9) scores collected over 12 months. An ensemble machine learning approach was used to detect long-term depression symptom variability via: (i) a domain-driven feature selection approach and (ii) an exhaustive feature-inclusion approach. SHapley Additive exPlanations (SHAP) were used to interrogate variable importance and directionality. The composite domain-driven and exhaustive inclusion models were both capable of moderately detecting long-term depression symptom variability (r = 0.33 and r = 0.39, respectively). Our results indicate the incremental predictive validity of sociodemographic, comorbidity, and passively collected wearable movement and sleep data in detecting long-term depression symptom variability.
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Affiliation(s)
- George D Price
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.
- Quantitative Biomedical Sciences Program, Dartmouth College, Lebanon, NH, USA.
| | - Michael V Heinz
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Seo Ho Song
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Matthew D Nemesure
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
- Quantitative Biomedical Sciences Program, Dartmouth College, Lebanon, NH, USA
- Digital Data Design Institute, Harvard Business School, Harvard University, Cambridge, MA, USA
| | - Nicholas C Jacobson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
- Quantitative Biomedical Sciences Program, Dartmouth College, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
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Richter M, Mota S, Hater L, Bratek R, Goltermann J, Barkhau C, Gruber M, Repple J, Storck M, Blitz R, Grotegerd D, Masuhr O, Jaeger U, Baune BT, Dugas M, Walter M, Dannlowski U, Buhlmann U, Back M, Opel N. Narcissistic dimensions and depressive symptoms in patients across mental disorders in cognitive behavioural therapy and in psychoanalytic interactional therapy in Germany: a prospective cohort study. Lancet Psychiatry 2023; 10:955-965. [PMID: 37844592 DOI: 10.1016/s2215-0366(23)00293-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Narcissistic personality traits have been theorised to negatively affect depressive symptoms, therapeutic alliance, and treatment outcome, even in the absence of narcissistic personality disorder. We aimed to examine how the dimensional narcissistic facets of admiration and rivalry affect depressive symptoms across treatment modalities in two transdiagnostic samples. METHODS We did a naturalistic, observational prospective cohort study in two independent adult samples in Germany: one sample pooled from an inpatient psychiatric clinic and an outpatient treatment service offering cognitive behavioural treatment (CBT), and one sample from an inpatient clinic providing psychoanalytic interactional therapy (PIT). Inpatients treated with CBT had an affective or psychotic disorder. For the other two sites, data from all service users were collected. We examined the effect of core narcissism and its facets admiration and rivalry, measured by Narcissistic Admiration and Rivalry Questionnaire-short version, on depressive symptoms, measured by Beck's Depression Inventory and Patient Health Questionnaire-Depression Scale, at baseline and after treatment in patients treated with CBT and PIT. Primary analyses were regression models, predicting baseline and post-treatment depression severity from core narcissism and its facets. Mediation analysis was done in the outpatient CBT group for the effect of the therapeutic alliance on the association between narcissism and depression severity after treatment. FINDINGS The sample included 2371 patients (1423 [60·0%] female and 948 [40·0%] male; mean age 33·13 years [SD 13·19; range 18-81), with 517 inpatients and 1052 outpatients in the CBT group, and 802 inpatients in the PIT group. Ethnicity data were not collected. Mean treatment duration was 300 days (SD 319) for CBT and 67 days (SD 26) for PIT. Core narcissism did not predict depression severity before treatment in either group, but narcissistic rivalry was associated with higher depressive symptom load at baseline (β 2·47 [95% CI 1·78 to 3·12] for CBT and 1·05 [0·54 to 1·55] for PIT) and narcissistic admiration showed the opposite effect (-2·02 [-2·62 to -1·41] for CBT and -0·64 [-1·11 to -0·17] for PIT). Poorer treatment response was predicted by core narcissism (β 0·79 [0·10 to 1·47]) and narcissistic rivalry (0·89 [0·19 to 1·58]) in CBT, whereas admiration showed no effect. No effect of narcissism on treatment outcome was discernible in PIT. Therapeutic alliance mediated the effect of narcissism on post-treatment depression severity in the outpatient CBT sample. INTERPRETATION As narcissism affects depression severity before and after treatment with CBT across psychiatric disorders, even in the absence of narcissistic personality disorder, the inclusion of dimensional assessments of narcissism should be considered in future research and clinical routines. The relevance of the therapeutic alliance and therapeutic strategy could be used to guide treatment approaches. FUNDING IZKF Münster. TRANSLATION For the German translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Maike Richter
- Institute for Translational Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
| | - Simon Mota
- Department of Psychology, University of Münster, Münster, Germany
| | - Leonie Hater
- Department of Psychology, University of Münster, Münster, Germany
| | - Rebecca Bratek
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Janik Goltermann
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Carlotta Barkhau
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Marius Gruber
- Institute for Translational Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Jonathan Repple
- Institute for Translational Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Michael Storck
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Rogério Blitz
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | | | | | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry, Melbourne Medical School, University of Melbourne Parkville, VIC, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne Parkville, VIC, Australia; Joint Institute for Individualisation in a Changing Environment (JICE), University of Münster and Bielefeld University, Münster, Germany
| | - Martin Dugas
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany; Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany; German Center for Mental Health (DZPG), Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany; Joint Institute for Individualisation in a Changing Environment (JICE), University of Münster and Bielefeld University, Münster, Germany
| | - Ulrike Buhlmann
- Department of Psychology, University of Münster, Münster, Germany
| | - Mitja Back
- Department of Psychology, University of Münster, Münster, Germany; Joint Institute for Individualisation in a Changing Environment (JICE), University of Münster and Bielefeld University, Münster, Germany
| | - Nils Opel
- Institute for Translational Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany; Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany; German Center for Mental Health (DZPG), Germany
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7
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Schönthaler EMD, Dalkner N, von Lewinski D, Reininghaus EZ, Baranyi A. Machiavellianism and psychopathy affect sleep quality in people with affective disorders and mentally healthy individuals. Front Psychol 2023; 14:1248931. [PMID: 37780148 PMCID: PMC10539687 DOI: 10.3389/fpsyg.2023.1248931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/31/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Deteriorated sleep quality is a predisposing factor and symptom of affective disorders (AD). It is important to investigate factors driving the relationship between sleep and AD, such as personality traits. Previous research has shown that personality traits such as the Dark Triad personality traits (DT) narcissism, Machiavellianism, and psychopathy are associated with sleep problems and AD. The current study examined the moderating influence of the DT in the relationship between AD [versus healthy controls (HC)] and sleep quality. Methods Data of 657 individuals (267 HC, 390 AD; 483 female, 166 male, eight diverse; Mage = 34.87, SDage = 13.86) were collected in an online survey, which administered the Pittsburgh Sleep Quality Index and the Short Dark Triad questionnaire. Results Moderation analyses controlling for age and gender revealed that Machiavellianism (b = -0.76, p < 0.05, R2 = 0.35) and psychopathy (b = -1.15, p < 0.05, R2 = 0.35), but not narcissism (b = -0.20, p = 0.620, R2 = 0.35), had a negative effect on sleep quality. Specifically, this effect is more pronounced in the HC group, but sleep quality is generally worse in AD. Conclusion Our findings indicate that Machiavellianism and psychopathy should be considered in the prevention and treatment of AD-associated sleep problems. Particularly, monitoring these traits could help to implement timely measures for the prevention of sleep problems, such as psychoeducation and sleep hygiene. The results highlight the role of personality in the aetiopathogenesis of AD and require further differentiation to examine the underlying pathways between the DT, sleep, and AD.
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Affiliation(s)
- Elena M. D. Schönthaler
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Nina Dalkner
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Dirk von Lewinski
- Clinical Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Eva Z. Reininghaus
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Andreas Baranyi
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
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Finch EF, Boccagno C, Hooley JM. Hurting the Grandiose Self: Examining Presence, Frequency, and Functions of Nonsuicidal Self-Injury in Pathological Narcissism. J Pers Disord 2023; 37:424-443. [PMID: 37721781 DOI: 10.1521/pedi.2023.37.4.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
The present study examines whether dimensions of pathological narcissism are associated with the presence, frequency, and function of nonsuicidal self-injury (NSSI). Adults (N = 252) completed questionnaires assessing narcissistic grandiosity, narcissistic vulnerability, fluctuation between these narcissistic states, and borderline personality disorder (BPD) symptoms. Those with a history of NSSI (n = 105) also reported the method, frequency, and function of their NSSI engagement. When controlling for co-occurring BPD symptoms, there were very few associations between vulnerability, grandiosity, and narcissistic fluctuation and NSSI presence and frequency. However, a clear pattern emerged regarding NSSI functions. Although vulnerability and narcissistic fluctuation were not associated with any functions of NSSI when co-occurring BPD symptoms were controlled for, grandiosity was positively associated with all interpersonal functions of NSSI (e.g., peer bonding, revenge) and negatively associated with the intrapersonal function of affect regulation. These results suggest a unique relationship between narcissistic grandiosity and NSSI that may inform clinical intervention.
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Affiliation(s)
- Ellen F Finch
- From Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Chelsea Boccagno
- From Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Jill M Hooley
- From Department of Psychology, Harvard University, Cambridge, Massachusetts
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Di Pierro R, Costantini G, Fanti E, Di Sarno M, Preti E, Madeddu F, Clarkin JF, Caligor E, De Panfilis C. Measurement Invariance of the Pathological Narcissism Inventory and Multimethod Examination of Narcissistic Presentations in Community and Clinical Samples. Assessment 2023; 30:1391-1406. [PMID: 35699415 DOI: 10.1177/10731911221101367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Pathological Narcissism Inventory (PNI) is extensively used in recent empirical literature on pathological narcissism. However, most studies using the PNI are community-based, and no studies have used the PNI to investigate narcissistic presentations in personality disordered patients. This study investigates measurement invariance of the PNI in community participants and patients with personality disorders, and examines differences of narcissistic presentations in these samples through a multimethod approach. Results show that the PNI can be used reliably to measure and compare traits of pathological narcissism in community participants and patients with personality disorders. Personality disordered patients show higher traits reflecting vulnerable narcissism and overt manifestations of grandiose narcissism, compared with controls. Finally, network analysis indicates that traits of grandiose fantasies and entitlement rage have a central role in defining manifestations of PNI pathological narcissism, regardless of the presence of an underlying personality disorder. Research and clinical implications are discussed.
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Affiliation(s)
- Rossella Di Pierro
- University of Milano-Bicocca, Italy
- Personality Disorders Lab, Parma-Milan, Italy
| | | | | | | | - Emanuele Preti
- University of Milano-Bicocca, Italy
- Personality Disorders Lab, Parma-Milan, Italy
| | - Fabio Madeddu
- University of Milano-Bicocca, Italy
- Personality Disorders Lab, Parma-Milan, Italy
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Ronningstam E, Weinberg I. Narcissistic Personality Disorder: Patterns, Processes, and Indicators of Change in Long-Term Psychotherapy. J Pers Disord 2023; 37:337-357. [PMID: 37367820 DOI: 10.1521/pedi.2023.37.3.337] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Change in treatment of narcissistic personality disorder (NPD) has been considered difficult to attain. Aspects of narcissistic pathology, including interpersonal enhancement, avoidance, aggressivity, and control, have contributed to challenges in forming a therapeutic alliance and pursuing treatment towards attainable goals for change and remission. This study, based on a qualitative review of therapists' case reports of individual psychotherapy with eight patients diagnosed with NPD, is the first to identify and explore patterns, processes, and indicators of change in pathological narcissism. All patients showed significant improvement in personality and life functioning, including engagement in work or education and long-term close relationships, with remission of the NPD diagnosis. The process of change was gradual, with some noticeable changes occurring in specific life contexts. Additional factors indicating and contributing to change included patients' motivation and commitment to psychotherapy, reflective ability, emotion regulation, sense of agency, and interpersonal and social engagement.
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Affiliation(s)
- Elsa Ronningstam
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Igor Weinberg
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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11
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Ghinassi S, Fioravanti G, Casale S. Is shame responsible for maladaptive daydreaming among grandiose and vulnerable narcissists? A general population study. PERSONALITY AND INDIVIDUAL DIFFERENCES 2023. [DOI: 10.1016/j.paid.2023.112122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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12
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Di Sarno M, Frisina S, Madeddu F, Di Pierro R. Interpersonal perceptions in treatment sessions: Pathological narcissism predicts self-rater discrepancies. J Clin Psychol 2023; 79:1002-1020. [PMID: 36322920 DOI: 10.1002/jclp.23454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/12/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Evidence suggests that pathological narcissism impacts psychotherapy process and outcome. This study investigates whether traits of pathological narcissism account for distinctiveness (construal) of patients' interpersonal perceptions in treatment settings. METHODS Patients enrolled in psychological/psychotherapeutic treatment (N = 150) described a segment of a session in a written format and subsequently assessed both self- and clinician's behavior on the dimensions of dominance and hostility (patient-reported ratings), along with their pathological narcissistic traits. Three independent raters also assessed interpersonal behaviors (observer-reported ratings) based on the written session descriptions. Indices of construal were defined by the residuals of self-reported (net of observer-reported) ratings and were regressed onto pathological narcissistic traits. RESULTS No association emerged between pathological narcissism and construal in patients' perceptions of their clinicians. However, grandiose traits of pathological narcissism were related to distinctively perceiving oneself as more dominant, while vulnerable traits were related to distinctively perceiving oneself as more hostile. The former association (but not the latter) also held after incorporating additional observer ratings to investigate the robustness of the results. CONCLUSION Findings are discussed in light of treatment-related self-enhancement and self-concealment processes.
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Affiliation(s)
- Marco Di Sarno
- Department of Psychology, University of Milano-Bicocca, Milano, Italy.,Personality Disorders Lab (PDlab), Parma-Milano, Milano, Italy
| | - Simone Frisina
- Department of Psychology, University of Milano-Bicocca, Milano, Italy
| | - Fabio Madeddu
- Department of Psychology, University of Milano-Bicocca, Milano, Italy.,Personality Disorders Lab (PDlab), Parma-Milano, Milano, Italy
| | - Rossella Di Pierro
- Department of Psychology, University of Milano-Bicocca, Milano, Italy.,Personality Disorders Lab (PDlab), Parma-Milano, Milano, Italy
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13
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Malaeb D, Asan AE, Fekih-Romdhane F, Azzi V, El Dine AS, Hallit S, Pincus AL. Validation of the pathological narcissistic inventory (PNI) and its brief form (B-PNI) in the Arabic language. BMC Psychiatry 2023; 23:168. [PMID: 36922814 PMCID: PMC10018913 DOI: 10.1186/s12888-023-04644-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/28/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND The Pathological Narcissism Inventory (PNI) is a multidimensional measure developed to assess narcissistic grandiosity and narcissistic vulnerability. We aimed to validate the Arabic version of the original Pathological Narcissistic Inventory (PNI) and its brief form (B-PNI) in a community sample of Lebanese adults. METHODS The English language PNI items were translated into Arabic following a rigorous translation, back-translation, and linguistic evaluation. A total of 401 participants were administered the translated PNI, as well as previously validated Arabic versions of the Big Five Inventory-2, the Rosenberg Self-esteem Scale, the Patient Health Questionnaire (PHQ-9), and the Impulsivity-8 Scale. RESULTS Exploratory and confirmatory analyses supported the existence of seven first-order and two second-order factors of the PNI and B-PNI. Except for exploitativeness where females scored lower than males, no other significant differences by gender were observed for the remaining PNI subscale scores. Additionally, scores on all the subscales exhibited good reliability, while the associations with external measures supported the concurrent validity of the translated instrument. CONCLUSION The results of this study suggest that scores on the PNI and B-PNI are highly reliable with satisfactory concurrent and factorial validity, providing an assessment of broadly defined pathological narcissism among the Lebanese young adult population. The availability of the Arabic PNI and its brief form should facilitate improved understanding of pathological narcissism in Arabic cultures and the different factors that govern narcissistic personality pathology.
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Affiliation(s)
- Diana Malaeb
- grid.411884.00000 0004 1762 9788College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
- grid.444421.30000 0004 0417 6142School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - A. Esin Asan
- grid.29857.310000 0001 2097 4281Pennsylvania State University, University Park, PA USA
| | - Feten Fekih-Romdhane
- grid.12574.350000000122959819Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- grid.414302.00000 0004 0622 0397The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry Ibn Omrane, Razi Hospital, Tunis, Tunisia
| | - Vanessa Azzi
- grid.444434.70000 0001 2106 3658School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O Box 446, Jounieh, Lebanon
| | - Abir Sarray El Dine
- grid.444421.30000 0004 0417 6142Department of Biomedical Sciences, School of arts and Sciences, Lebanese International University, Beirut, Lebanon
| | - Souheil Hallit
- grid.444434.70000 0001 2106 3658School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O Box 446, Jounieh, Lebanon
- grid.512933.f0000 0004 0451 7867Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- grid.411423.10000 0004 0622 534XApplied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Aaron L. Pincus
- grid.29857.310000 0001 2097 4281Pennsylvania State University, University Park, PA USA
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14
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Profiles of patients with a personality disorder admitted in a day hospital treatment program: Revealing spectra from the Hierarchical Taxonomy of Psychopathology. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-023-04388-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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15
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Green A, MacLean R, Charles K. Clinician perception of pathological narcissism in females: a vignette-based study. Front Psychol 2023; 14:1090746. [PMID: 37151338 PMCID: PMC10157482 DOI: 10.3389/fpsyg.2023.1090746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 04/04/2023] [Indexed: 05/09/2023] Open
Abstract
The DSM-5 reports that up to 75% of those diagnosed with Narcissistic Personality Disorder (NPD) are males, which denotes that narcissism is a clinical phenomenon that operates differently in men and women. Vulnerable narcissism, which tends to be more prevalent in females and is currently under-appreciated in the DSM-5, may be diagnosed as other "vulnerable" disorders (e.g., Borderline Personality Disorder; BPD). The current study investigated gender differences in clinicians' perceptions of narcissistic pathology. Adopting an online vignette-based study, clinicians (N = 108; 79 females) read clinical case vignettes of hypothetical patients and provided diagnostic ratings of existing personality disorders. Clinicians' diagnostic ratings of NPD were concurrent with the vignette containing grandiose narcissism symptoms, irrespective of patient gender. However, when presented with a vulnerable narcissism vignette, clinicians were significantly more likely to attribute a BPD diagnosis in female patients, compared to male patients. Clinicians with a psychodynamic approach and more experience in practice were also more likely to label vulnerable narcissism symptoms as NPD, compared to those with a CBT approach and less experience in practice. The clinical implications of these results support the shift toward assessing personality dysfunction based on dimensional trait domains.
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Affiliation(s)
- Ava Green
- Department of Psychology, City, University of London, London, United Kingdom
- *Correspondence: Ava Green,
| | - Rory MacLean
- Department of Psychology, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Kathy Charles
- Centre for Academic Development and Quality, Nottingham Trent University, Nottingham, United Kingdom
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16
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Şen-Pakyürek G, Barışkın E. Narcissism on interpersonal circumplex model: Reactions to imaginary abandonment and rejection. Front Psychol 2022; 13:987038. [PMID: 36533012 PMCID: PMC9751938 DOI: 10.3389/fpsyg.2022.987038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/01/2022] [Indexed: 09/24/2023] Open
Abstract
AIM Narcissism is a direct result of the lack of self-expression. Thus, this trait is enshrined in cycles of strategies to protect self-worth in interpersonal relationships. The aim of the present study was to understand in what way narcissistic individuals understand their interactions with themselves and others. METHOD The study included two groups comprising high grandiose narcissism (GN, n = 43) and high vulnerable narcissism (VN, n = 44). The participants who received scores that were one standard deviation (SD) above the mean, either on the PNI-grandiosity or on the PNI-vulnerable dimensions, constituted the GN and VN groups among 518 students (Age: M = 23.57, Sd = 2.13). RESULTS The chi-square test was performed to evaluate the dimensions of narcissism with respect to responses of the participants and their partners (behavioral, cognitive, and emotional). The Pathological Narcissism Inventory (PNI) was administered to evaluate narcissistic characteristics. The "Criticism Story" of the Story Completion Inventory in Romantic Relationships (SCIRR) was used for criticism. The circular pattern between the responses of the participants and their partners was examined using the Interpersonal Schemas Scale (ISS). The results revealed that the vulnerable group gave more complementary responses emotionally and made more complementary predictions in terms of the expected reactions from the romantic partner than the grandiose group. DISCUSSION The results were discussed in reference to the basic self-esteem-protecting motivations of the groups.
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Affiliation(s)
- Gamze Şen-Pakyürek
- Department of Clinical Psychology, Manisa Celal Bayar University, Manisa, Turkey
| | - Elif Barışkın
- Department of Clinical Psychology, Hacettepe University, Ankara, Turkey
- Department of Psychology, TED University, Ankara, Turkey
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17
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Abstract
Despite putative gender differences in the expression of narcissism, prominent theories have virtually dismissed the role of females in the development and manifestation of narcissism. The contention that narcissism is a pathology of the self that may partly differ in males and females is further evident in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 reports that up to 75% of those diagnosed with Narcissistic Personality Disorder (NPD) are men. Such figures suggest that the representation of narcissism as codified in the DSM-5 may only be marginally applicable to females, given its prominent focus and nature on capturing grandiose themes which closely resemble commonly masculine norms. The overemphasis on grandiose features extends to the empirical literature which defines narcissism as a normative personality trait and is widely assessed using the Narcissistic Personality Inventory (NPI), on which males obtain significantly higher scores than females. As this review will demonstrate, one limitation frequently occurring in the literature is the attempt to comprehend narcissistic manifestations in females through the lens of what has commonly been defined as narcissism (DSM/NPI). In this review, the literature concerning the diagnostic assessment and conceptualisation of narcissistic personality disorder, aetiological factors, aggression, and partner violence perpetration will be discussed in relation to the importance of gender. This is followed by a review of existing gaps in theory and research, and suggestions for fruitful directions that can aid a richer and more meaningful literature on narcissism inclusive of gender issues.
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Affiliation(s)
- Ava Green
- City University of London, Department of Psychology, London, UK
| | - Rory MacLean
- Edinburgh Napier University, School of Applied Sciences, Edinburgh, UK
| | - Kathy Charles
- Nottingham Trent University, Centre for Academic Development and Quality, Nottingham, UK
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18
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Weinberg I, Ronningstam E. Narcissistic Personality Disorder: Progress in Understanding and Treatment. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:368-377. [PMID: 37200887 PMCID: PMC10187400 DOI: 10.1176/appi.focus.20220052] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This review summarizes current knowledge about narcissistic personality disorder (NPD). Each section brings the reader up to date on advances in our knowledge during the last decade. In terms of NPD diagnosis, this review describes the addition of the dimensional model to the categorical model. The accumulating knowledge has led to the description of grandiose and vulnerable narcissism as well as their complex interrelationship. Strong support exists for co-occurrence of these presentations among people with high levels of grandiose narcissism. Studies have identified mechanisms, in domains such as self-esteem dysregulation, emotion dysregulation, cognitive style, interpersonal relations, and empathy, and possible developmental and temperamental antecedents of the disorder. Thus, it appears that NPD has a multifactorial etiology and pathogenesis, with numerous mechanisms associated with each area of dysfunction. Longitudinal studies support the view that these patients can improve, but such improvement is gradual and slow. Several treatments have been developed for the disorder, and a majority share commonalities, including clear goals, attention to treatment frame, attention to relationships and self-esteem, alliance building, and monitoring of countertransference.
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Affiliation(s)
- Igor Weinberg
- Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, Massachusetts
| | - Elsa Ronningstam
- Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, Massachusetts
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19
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Cohen CT, Hulsey TL. Object Relations-Focused Psychoanalytic Psychotherapy in the Treatment of Narcissistic Personality Disorder. Clin Case Stud 2022. [DOI: 10.1177/15346501221098071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current study examines the psychotherapeutic treatment of an early-20s Caucasian male diagnosed with narcissistic personality disorder. The patient was treated with 56 sessions of psychoanalytic psychotherapy utilizing an object relations approach. Treatment aimed at decreasing the patient’s anger, anxiety, depression, and improving emotion regulation. Another focus of this patient’s treatment was helping him gain insight into the nature of his unconscious predictions and interpretations of others’ behavior in the hope that he may begin to experience relationships with greater emotional connection and less conflict. Treatment outcomes were measured using Reliable Change Index analyses, which indicated a significant reduction in anxiety, depression, anger, and emotion regulation difficulty between the beginning of treatment and the most recent session. The patient also demonstrated increased mentalization abilities and fewer anger outbursts throughout the course of treatment. During the sessions surrounding a therapeutic rupture, the patient’s emotion regulation abilities worsened temporarily; therapy shifted during this time to a more supportive analytic framework. An object relations-focused theoretical background and clinical treatment implications are discussed in relation to this case.
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20
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Choi-Kain LW, Simonsen S, Euler S. A Mentalizing Approach for Narcissistic Personality Disorder: Moving From "Me-Mode" to "We-Mode". Am J Psychother 2022; 75:38-43. [PMID: 35016552 DOI: 10.1176/appi.psychotherapy.20210017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Narcissistic personality disorder (NPD) is a prevalent condition that frequently co-occurs with other diagnoses that bring patients into treatment. Narcissistic disturbances are not often the chief complaint, but they complicate the development of an adequate therapeutic alliance. Typical countertransference challenges, combined with stigma related to NPD, result in difficulty for the therapist to relate to these patients empathically. Mentalization-based treatment provides a means for therapists to reach these patients by taking a "not-knowing" stance with interest and curiosity in clarifying and expanding a shared awareness of the patient's emotional experiences. By understanding the attachment functions, mentalizing imbalances, and problems of epistemic disregard among patients with NPD, therapists can break through the self-centered "me-mode" of the therapeutic dyad, where the typical lack of engagement or power struggles prevail, to a "we-mode," where the patient and therapist are joined in attention to what happens in the patient's mind and in interactions with others.
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Affiliation(s)
- Lois W Choi-Kain
- Gunderson Personality Disorders Institute, McLean Hospital, Belmont, Massachusetts, (Choi-Kain); Department of Psychiatry, Harvard Medical School, Boston (Choi-Kain); Stolpegaard Psychotherapy Center, Mental Health Services, Capital Region, Gentofte, Denmark (Simonsen); University Psychiatric Clinics Basel, Basel, Switzerland (Euler)
| | - Sebastian Simonsen
- Gunderson Personality Disorders Institute, McLean Hospital, Belmont, Massachusetts, (Choi-Kain); Department of Psychiatry, Harvard Medical School, Boston (Choi-Kain); Stolpegaard Psychotherapy Center, Mental Health Services, Capital Region, Gentofte, Denmark (Simonsen); University Psychiatric Clinics Basel, Basel, Switzerland (Euler)
| | - Sebastian Euler
- Gunderson Personality Disorders Institute, McLean Hospital, Belmont, Massachusetts, (Choi-Kain); Department of Psychiatry, Harvard Medical School, Boston (Choi-Kain); Stolpegaard Psychotherapy Center, Mental Health Services, Capital Region, Gentofte, Denmark (Simonsen); University Psychiatric Clinics Basel, Basel, Switzerland (Euler)
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21
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Euler S, Hüwe L, Gablonski TC, Dehoust M, Schulz H, Brütt AL, Andreas S. Mentalizing Mediates the Association between Narcissism and Psychotherapeutic Treatment Outcome in a Mixed Clinical Sample. Psychopathology 2022; 55:282-291. [PMID: 35439763 DOI: 10.1159/000524203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Pathological narcissism has been a challenge for the success of psychological treatment, whereas mentalizing has turned out to be an important mechanism of change in psychotherapy. This study focused on the classic narcissistic self (CNS) (i.e., narcissistic grandiosity) as predictor of the outcome. It further investigated whether mentalizing mediates this relation. METHODS A mixed clinical sample of 205 patients was investigated. The CNS scale of the Narcissism Inventory and the Mentalization Questionnaire was used to measure the features of narcissistic grandiosity and the capacity to mentalize, respectively. The symptom outcome was assessed with the Hamburg Modules for the Assessment of Psychosocial Health. RESULTS Contrary to our expectations, we did not find a direct association between narcissistic grandiosity and a decrease in symptoms. However, mentalizing was found to mediate the association between the CNS as well as between the narcissistic furor and outcome. CONCLUSION Our results confirm the ambiguity concerning the clinical significance of narcissistic grandiosity. However, in order to improve the treatment outcome in patients with narcissistic features, especially narcissistic furor, individualized treatment plans might consider introducing interventions that enhance the capacity to mentalize.
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Affiliation(s)
- Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital Zurich, Zurich, Switzerland
| | - Lotta Hüwe
- Institute for Psychology, University Klagenfurt, Klagenfurt, Austria
| | | | | | - Holger Schulz
- Institute for Medical Psychology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Anna-Levke Brütt
- Institute for Medical Psychology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Sylke Andreas
- Institute for Psychology, University Klagenfurt, Klagenfurt, Austria,
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22
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Kampe L, Bohn J, Remmers C, Hörz-Sagstetter S. It's Not That Great Anymore: The Central Role of Defense Mechanisms in Grandiose and Vulnerable Narcissism. Front Psychiatry 2021; 12:661948. [PMID: 34177651 PMCID: PMC8226035 DOI: 10.3389/fpsyt.2021.661948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/06/2021] [Indexed: 12/01/2022] Open
Abstract
Objectives: The concept of narcissism contains a yet unresolved paradox: Its grandiose facet depicts the psychopathological core but is often associated with life-satisfaction and overall functioning, whereas its vulnerable facet is associated with psychological distress, but still not included in the international classification systems. Our goal was to investigate the relationship between the two facets of narcissism expecting underlying defense mechanisms to be core elements. First, we aimed to identify defense mechanisms specific to grandiose and vulnerable narcissism. Second, we explored how both facets are differentially associated with psychological distress, assuming that grandiose narcissism would be associated with less psychological distress than vulnerable narcissism. Third, we investigated the mediating role of defense mechanisms between narcissism and psychological distress. Methods: In a non-clinical sample of N = 254 individuals, the Pathological Narcissism Inventory was used for the assessment of grandiose and vulnerable facets of narcissism, the Defense Style Questionnaire for defense mechanisms, and the Brief Symptom Inventory for psychological distress. Structural equation modeling was employed to identify distinct factors of grandiose and vulnerable narcissism. Associations between specific defense mechanisms and both facets were calculated. Furthermore, the direct association between both facets and psychological distress was examined. We finally explored whether defense mechanisms mediate the association between distress and both grandiose and vulnerable narcissism. Results: A distinct pattern of defense mechanisms for each facet of narcissism could be extracted: Both facets showed significant positive correlations with specific intermediate and all maladaptive defense mechanisms. Only grandiose narcissism showed significant positive correlations with adaptive defenses. Vulnerable narcissism showed negative correlations with all adaptive defenses. Specifically, grandiose narcissism was significantly related to anticipation, pseudo-altruism, rationalization, and dissociation, whereas vulnerable narcissism was negatively related to all these defense mechanisms. While grandiose narcissism was not related to psychological distress, vulnerable narcissism showed high correlations with psychological distress. Intriguingly, mediator analysis found that grandiose narcissism was related to psychological distress when mediated by maladaptive defense mechanisms. Discussion: The role of defense mechanisms is central for a differentiated understanding of the two different faces of narcissism. The relevance of assessing defense mechanisms in clinical settings, and related empirical findings are discussed.
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Affiliation(s)
- Leonie Kampe
- Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Psychosoziales Zentrum Itzehoe, Itzehoe, Germany
| | - Johannes Bohn
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Carina Remmers
- Faculty of Health/School of Psychology and Psychiatry, Witten/Herdecke University, Witten, Germany
| | - Susanne Hörz-Sagstetter
- Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
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23
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Ponzoni S, Beomonte Zobel S, Rogier G, Velotti P. Emotion dysregulation acts in the relationship between vulnerable narcissism and suicidal ideation. Scand J Psychol 2021; 62:468-475. [PMID: 33956346 PMCID: PMC8360132 DOI: 10.1111/sjop.12730] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 03/17/2021] [Accepted: 04/04/2021] [Indexed: 12/23/2022]
Abstract
Suicide behaviors are peculiar aspects of several cluster B disorders, including Narcissistic Personality Disorder. To date, it is still unclear which facet of narcissism is more related to the desire to die and which other factors are involved in this relationship. This study aims to offer preliminary empirical evidences concerning the relationship between narcissism, emotion dysregulation and suicide ideation. We administered the Pathological Narcissism Inventory (PNI), Difficulties in Emotion Regulation Scale (DERS), PID‐5‐BF (Personality Inventory for DSM‐5‐Short Form) and Beck Scale for Suicide ideation (BSI) to a sample of individuals with suicide ideation (n = 70) and a sample of community participants (n = 154). Controlling for age, gender and Negative Affectivity, we found that BSI scores correlated significantly with the vulnerable dimension of narcissism, but not with the grandiose one, and with all DERS dimension, apart from Awareness. Nevertheless, emotion dysregulation moderates the relationship between vulnerable narcissism and suicide ideation. Suicide ideation seems to be deeply connected with the vulnerable dimension of pathological narcissism and the relationship between the constructs is totally mediated by emotion dysregulation. Future directions and clinical implications are discussed.
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Affiliation(s)
- Sara Ponzoni
- Department of Educational Sciences, University of Genoa, Italy
| | - Sara Beomonte Zobel
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Guyonne Rogier
- Department of Educational Sciences, University of Genoa, Italy
| | - Patrizia Velotti
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
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24
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Edershile EA, Wright AGC. Fluctuations in grandiose and vulnerable narcissistic states: A momentary perspective. J Pers Soc Psychol 2021; 120:1386-1414. [PMID: 33090821 PMCID: PMC8060359 DOI: 10.1037/pspp0000370] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Theories of narcissism emphasize the dynamic processes within and between grandiosity and vulnerability. Research seeking to address this has either not studied grandiosity and vulnerability together or has used dispositional measures to assess what are considered to be momentary states. Emerging models of narcissism suggest grandiosity and vulnerability can further be differentiated into a three-factor structure-Exhibitionistic Grandiosity, Entitlement, and Vulnerability. Research in other areas of maladaptive personality (e.g., borderline personality disorder) has made headway in engaging data collection and analytic methods that are specifically meant to examine such questions. The present study took an exploratory approach to studying fluctuations within and between grandiose and vulnerable states. Fluctuations-operationalized as gross variability, instability, and lagged effects-were examined across three samples (two undergraduate and a community sample oversampled for narcissistic features; total person N = 862, total observation N = 36,631). Results suggest variability in narcissistic states from moment to moment is moderately associated with dispositional assessments of narcissism. Specifically, individuals who are dispositionally grandiose express both grandiosity and vulnerability, and vary in their overall levels of grandiosity and vulnerability over time. On the other hand, dispositionally vulnerable individuals tend to have high levels of vulnerability and low levels of grandiosity. Entitlement plays a key role in the processes that underlie narcissism and narcissistic processes appear unique to the construct and not reflective of broader psychological processes (e.g., self-esteem). Future research should consider using similar methods and statistical techniques on different timescales to study dynamics within narcissism. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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25
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Busmann M, Meyer AH, Wrege J, Lang UE, Gaab J, Walter M, Euler S. Vulnerable narcissism as beneficial factor for the therapeutic alliance in borderline personality disorder. Clin Psychol Psychother 2021; 28:1222-1229. [PMID: 33619789 DOI: 10.1002/cpp.2570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 01/23/2021] [Accepted: 01/24/2021] [Indexed: 01/13/2023]
Abstract
Evidence suggests that narcissism and borderline personality disorder are associated with each other. This naturalistic study investigated the predictive value of grandiose and vulnerable narcissism on the development of the therapeutic alliance in short-term psychodynamic treatment across 12 weeks. The sample consisted of 99 patients with borderline personality disorder. Narcissism was assessed with the Pathological Narcissism Inventory at treatment onset. The therapeutic alliance was rated with the Scale to Assess Therapeutic Relationships by both patient and therapist at four time points during treatment. Results showed a significant predictive value of vulnerable narcissism on the therapeutic alliance, revealing a more beneficial progression for patients with higher vulnerable narcissism. Grandiose narcissism had no predictive value on the therapeutic alliance. The study strengthens the clinical utility of the concept of vulnerable narcissism towards the evaluation of treatment processes in borderline personality disorder.
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Affiliation(s)
- Mareike Busmann
- Psychiatric University Hospital Basel, Centre of Psychosomatics and Psychotherapy, Basel, Switzerland
| | - Andrea H Meyer
- Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Johannes Wrege
- Psychiatric University Hospital Basel, Centre of Psychosomatics and Psychotherapy, Basel, Switzerland
| | - Undine E Lang
- Psychiatric University Hospital Basel, Centre of Psychosomatics and Psychotherapy, Basel, Switzerland
| | - Jens Gaab
- Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Marc Walter
- Psychiatric University Hospital Basel, Centre of Psychosomatics and Psychotherapy, Basel, Switzerland
| | - Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital Zürich, Zürich, Switzerland
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26
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Janusz B, Bergmann JR, Matusiak F, Peräkylä A. Practices of Claiming Control and Independence in Couple Therapy With Narcissism. Front Psychol 2021; 11:596842. [PMID: 33569022 PMCID: PMC7868443 DOI: 10.3389/fpsyg.2020.596842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/07/2020] [Indexed: 11/25/2022] Open
Abstract
Four couple therapy first consultations involving clients with diagnosed narcissistic problems were examined. A sociologically enriched and broadened concept of narcissistic disorder was worked out based on Goffman’s micro-sociology of the self. Conversation analytic methods were used to study in detail episodes in which clients resist to answer a therapist’s question, block or dominate the development of the conversation’s topic, or conspicuously display their interactional independence. These activities are interpreted as a pattern of controlling practices that were prompted by threats that the first couple therapy consultation imposes upon the clients’ self-image. The results were discussed in the light of contemporary psychiatric discussions of narcissism; the authors suggest that beyond its conceptualization as a personality disorder, narcissism should be understood as a pattern of interactional practices.
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Affiliation(s)
- Bernadetta Janusz
- Department of Family Therapy and Psychosomatics, Jagiellonian University, Medical College, Kraków, Poland
| | - Jörg R Bergmann
- Faculty of Sociology, Bielefeld University, Bielefeld, Germany
| | - Feliks Matusiak
- Department of Child and Adolescent Psychiatry, Medical Colleague Kraków, Poland
| | - Anssi Peräkylä
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
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27
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Cain NM, Jowers C, Blanchard M, Nelson S, Huprich SK. Examining the Interpersonal Profiles and Nomological Network Associated with Narcissistic Grandiosity and Narcissistic Vulnerability. Psychopathology 2021; 54:26-38. [PMID: 33440399 DOI: 10.1159/000510475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 07/24/2020] [Indexed: 11/19/2022]
Abstract
Theory and research have consistently shown that pathological narcissism can best be described by 2 phenotypic expressions, narcissistic grandiosity and narcissistic vulnerability. The current study sought to examine the specific types of interpersonal problems reported by those high in narcissistic grandiosity and high in narcissistic vulnerability as well as examine the nomological network associated with these 2 manifestations of narcissism. In a sample of university students who completed self-report measures of pathological narcissism, interpersonal problems, depression, self-esteem, malignant self-regard, self-defeating personality disorder symptoms, and anger, we found that narcissistic grandiosity (n = 108) was associated with one distinct interpersonal profile, for example, being overly intrusive in relationships with others, while narcissistic vulnerability (n = 88) was associated with a wider range of interpersonal problems on the interpersonal circumplex. Using cluster analysis, we found 3 interpersonal subtypes associated with narcissistic vulnerability, an intrusive subtype, a cold subtype, and a socially avoidant subtype. Further examination of group differences showed that the 3 interpersonal subtypes associated with narcissistic vulnerability could also be distinguished based on their experience and expression of anger. This suggests the importance of assessing profiles of interpersonal functioning and anger in narcissistic vulnerability. The clinical implications of our results are discussed.
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Affiliation(s)
- Nicole M Cain
- Department of Clinical Psychology, Rutgers University, Piscataway, New Jersey, USA,
| | - Callie Jowers
- Department of Psychology, University of Detroit Mercy, Detroit, Michigan, USA
| | - Mark Blanchard
- Department of Psychology, University of Detroit Mercy, Detroit, Michigan, USA
| | - Sharon Nelson
- Department of Psychology, University of Detroit Mercy, Detroit, Michigan, USA
| | - Steven K Huprich
- Department of Psychology, University of Detroit Mercy, Detroit, Michigan, USA
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28
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Abstract
Pathological narcissism is associated with decreased quality of life, even when accounting for psychiatric comorbidity, but the processes behind this association are unclear. Here, we evaluate whether disturbed relatedness accounts for the negative association between narcissistic pathology and quality of life. Patients in day hospital treatment for personality pathology (N = 218, 70% female; mean age, 37.3 years) completed measures of personality disorder features, quality of life, and global symptoms before beginning treatment. Quality of object relations was assessed through semistructured interviews. Regression-based mediation analyses showed that narcissistic personality traits relate to quality of life through quality of object relations, controlling for other personality disorders and psychiatric distress. These results highlight the importance of problematic relationship patterns for the low quality of life associated with pathological narcissism. Clinicians working with narcissistic individuals should consider psychotherapies that promote mature relatedness and should attend to facilitating the quality of patients' relationships.
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Clinical and personality profile of depressed suicide attempters: A preliminary study at the open-door policy Mood Disorder Unit of San Raffaele Hospital. Psychiatry Res 2020; 287:112575. [PMID: 31587915 DOI: 10.1016/j.psychres.2019.112575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/18/2019] [Accepted: 09/21/2019] [Indexed: 11/22/2022]
Abstract
Suicidal behavior is a complex phenomenon with high rates among psychiatric inpatients. Mood disorders and personality dysfunctions represent relevant risk factors for suicides attempts and suicidal ideation. Our study aims to investigate the role of the co-occurrence of clinical variables (duration of depressive state, previous suicide attempts), socio-demographic variables (gender, employment and civil status) and narcissistic personality features in the suicide risk of admitted psychiatric patients affected by a mood disorder. The sample was composed of 93 patients consecutively admitted in an open ward psychiatric Unit. Forty-eight participants had a positive history of previous suicide attempts: the suicide attempters (SA) were mostly female, unemployed and married. The SA group were observed to have suffered from a depressive episode with a longer duration; moreover in the SA group, the presence of active suicidal ideation was significantly related to a higher number of previous suicide attempts. In the whole sample, suicidal ideation was significantly related to narcissistic vulnerability personality features. Using a multidimensional approach, the present study allows a preliminary profiling of patients at risk for suicidal behavior during hospitalization.
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Hemmati A, Weiss B, Mirani A, Rezaei F, Miller JD. Examining the Contribution of Perfectionistic Traits to the Construct Validity of the DSM-5 Alternative Model of Personality Disorder. J Pers Disord 2020:1-18. [PMID: 32250207 DOI: 10.1521/pedi_2020_34_476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Scholars of perfectionism have proposed significant modifications to DSM-5's alternative model of personality disorders (AMPD), such that (1) perfectionism be expanded beyond the inclusion of a singular trait-rigid perfectionism-and (2) perfectionistic traits be specified as trait descriptors of personality disorders (PDs) other than obsessive-compulsive PD. In this study, we evaluate these proposals by examining the degree to which (a) perfectionistic traits are already instantiated in Section II and Section III models of personality pathology; and (b) perfectionistic traits meaningfully augment the construct validity of AMPD PDs. We conducted these approaches in a large sample (N =3D 435) from an Iranian undergraduate population that is atypically found in the literature. Results showed that perfectionistic traits are already fairly well instantiated in Section III Criterion B. Perfectionistic traits minimally improved the construct validity of OCPD, but did not meaningfully do so for other PDs. Future investigation into the clinical utility of perfectionistic traits is needed.
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Affiliation(s)
| | | | | | - Farzin Rezaei
- Neurosciences Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Abstract
This article identifies guiding principles in effective psychotherapies of patients with narcissistic personality disorder (NPD) and cautions against some common pitfalls. Individual psychotherapies of NPD patients were examined by both authors, who tested whether or not some principles, recommended in the literature, effectively promote these therapies and help these patients in moving forward with their lives and with effective therapy use. The authors identify a number of principles that were associated with more positive therapy development: helping patients identify goals and direction of their therapies, promoting a sense of agency, promoting a shift of focus to sense of vulnerability, and anticipating difficulty in developing and maintaining the treatment alliance. Common mistakes in these treatments are engaging in a power struggle with the patient, overindulging the grandiosity of the patient, directly challenging the grandiosity of the patient, and ignoring treatment-interfering behaviors. Identification of principles of effective therapies with NPD patients can help with the development of more effective treatment approaches for NPD.
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Ronningstam E. Internal Processing in Patients With Pathological Narcissism or Narcissistic Personality Disorder: Implications for Alliance Building and Therapeutic Strategies. J Pers Disord 2020; 34:80-103. [PMID: 32186980 DOI: 10.1521/pedi.2020.34.supp.80] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pathological narcissism (PN) and narcissistic personality disorder (NPD) have primarily been identified by striking external features, such as superiority, attention seeking and a critical or condescending attitude, and less attention has been paid to the internal processing contributing to this particular personality functioning. High dropout from treatment and challenges in building a therapeutic alliance with these patients call for further understanding of the complexity of disordered narcissism. Recent research on neuropsychological underpinnings to narcissistic pathology have provided valuable information that can inform therapeutic interventions for patients with this personality pathology. Internal processing in patients with PN or NPD is specifically influenced by compromised emotion processing and tolerance, identity diffusion, fluctuating sense of agency, reflective ability, perfectionism-related self- esteem, and ability to symbolize. The aim of this article is to review research studies with relevance for internal processing related to disordered narcissism and integrate findings with therapeutic strategies in alliance building with these patients.
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Affiliation(s)
- Elsa Ronningstam
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Diamond D, Hersh RG. Transference-Focused Psychotherapy for Narcissistic Personality Disorder: An Object Relations Approach. J Pers Disord 2020; 34:159-176. [PMID: 32186988 DOI: 10.1521/pedi.2020.34.supp.159] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Transference-focused psychotherapy (TFP) is an empirically validated psychodynamic psychotherapy for borderline personality disorder (BPD), based on object relations theory, that has clinical utility for individuals with narcissistic personality disorder (NPD). Given the effectiveness of TFP for patients with BPD, including a number of patients with comorbid NPD, we have adapted the tactics and techniques of TFP with specific modifications for patients with NPD or narcissistic traits. TFP for NPD (TFP-N) retains core elements of the treatment, including a contracting phase and an interpretive process designed to identify and modify maladaptive mental representations of self and others that underlie the affect and behavioral dysregulation in those with personality disorders including NPD. The major goal of TFP-N is the focus on disturbed interpersonal patterns of relating in the here-and-now of the therapeutic interaction as a vehicle to effect enduring changes in personality organization and real-world changes in the areas of love and work.
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Affiliation(s)
- Diana Diamond
- Department of Psychology, City University of New York, Weill Cornell Medical College, New York, New York
| | - Richard G Hersh
- Columbia University Medical Center, Columbia Center for Psychoanalytic Training and Research, New York, New York
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Pathological Narcissism and Symptoms of Major Depressive Disorder Among Psychiatric Outpatients: The Mediating Role of Impaired Emotional Processing. J Nerv Ment Dis 2020; 208:161-164. [PMID: 31977828 DOI: 10.1097/nmd.0000000000001114] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Research is scarce regarding the mechanisms by which pathological narcissism--consisting of narcissistic grandiosity and vulnerability--is linked with depression. The present study examined whether impaired emotional processing would mediate relations between pathological narcissism domains and depressive symptoms in a sample of 99 psychiatric outpatients. A significant indirect effect was found for narcissistic vulnerability on depressive symptoms, through unprocessed emotion as a mediator. Findings suggest that narcissistic vulnerability contributes to persistent and intrusive negative feelings, which in turn contribute to depressive symptom severity.
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Hersh RG, McCommon B, Golkin EG. Sharing a Diagnosis of Narcissistic Personality: a Challenging Decision with Associated Risks and Benefits. Curr Behav Neurosci Rep 2019. [DOI: 10.1007/s40473-019-00193-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Somma A, Pincus AL, Fontana A, Cianfanelli B, Fossati A. Measurement Invariance of Three Versions of the Pathological Narcissism Inventory across Gender-Matched Italian Adolescent High School and Young Adult University Students. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2019. [DOI: 10.1007/s10862-019-09758-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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38
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Dashineau SC, Edershile EA, Simms LJ, Wright AGC. Pathological narcissism and psychosocial functioning. Personal Disord 2019; 10:473-478. [PMID: 31259606 DOI: 10.1037/per0000347] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Pathological narcissism involves maladaptive efforts to regulate the self and is conceptualized by 2 key features: narcissistic grandiosity and narcissistic vulnerability. Prior research has found that narcissism is associated with poorer functioning over the long term, especially interpersonal functioning. Despite this, the specific contributions of grandiosity and vulnerability to different domains of functioning remain understudied. In particular, there has been scant literature investigating pathological narcissism and its effects on functioning in large clinical samples. Understanding how grandiosity and vulnerability each contributes to dysfunction will help inform the conceptualization, prognosis, and treatment recommendations, alike, for narcissism. This study examined the relations between narcissism and different domains of dysfunction in a sample of 288 current or recent psychiatric outpatients. Results suggest that narcissistic grandiosity is associated with specific deficits in interpersonal functioning, whereas vulnerability is associated with all forms of dysfunction. However, after accounting for the shared variance in the predictors, vulnerability continues to be predictive of all forms of dysfunction, whereas grandiosity serves as a modest protective factor. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Bell CA, Jankowski PJ, Sandage SJ. Early treatment narcissism associated with later social and sexual functioning among psychotherapy clients. COUNSELLING & PSYCHOTHERAPY RESEARCH 2019. [DOI: 10.1002/capr.12199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | - Peter J. Jankowski
- Boston University; Boston Massachusetts
- Bethel University; Saint Paul Minnesota
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Spencer CC, Foster JD, Bedwell JS. Structural Relationships Among the Revised Reinforcement Sensitivity Theory and Grandiose and Vulnerable Narcissism. J Pers Disord 2018; 32:654-667. [PMID: 28926305 DOI: 10.1521/pedi_2017_31_318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Research shows that grandiosity and vulnerability are distinct aspects of narcissism. The Contemporary Clinical Model (CCM) of narcissism suggests that individuals fluctuate between grandiose narcissism (GN) and vulnerable narcissism (VN). The authors examine the relative contributions of the Behavioral Approach System (BAS), the Behavioral Inhibition System (BIS), and the Fight-Flight-Freeze System (FFFS) in the Revised Reinforcement Sensitivity Theory of Personality (r-RST) to GN and VN. Few studies examine the r-RST, and even fewer examine the VN and GN distinction. To remain consistent with the CCM, structural equation modeling was used to account for individuals' relative levels of VN and GN. Across two independent samples (Ns = 854 and 258), results indicated that GN is associated with higher BAS scores and that VN is associated with higher BIS scores. Relations among GN, VN, and FFFS were inconsistent between samples. Implications of the r-RST results are interpreted within the context of the CCM.
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Affiliation(s)
| | - Joshua D Foster
- Department of Psychology, University of South Alabama, Mobile, Alabama
| | - Jeffrey S Bedwell
- Department of Psychology, University of Central Florida, Orlando, Florida
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Narcissism and Interpersonal Problems Among Psychiatric Outpatients: What Is the Role of Defensive Style? J Nerv Ment Dis 2018; 206:711-715. [PMID: 30124571 DOI: 10.1097/nmd.0000000000000871] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A growing body of evidence points to significant interpersonal problems associated with narcissism in clinical samples. Less well understood are the mechanisms by which narcissism negatively impacts one's interpersonal functioning. The present study investigated defensive style as a possible mediator of the relationship between narcissism and interpersonal problems. A sample of 53 adult psychiatric outpatients completed measures of narcissism, defensive style, interpersonal problems, and current symptom distress. Mediation analysis was conducted, controlling for current symptom distress, using 95% bootstrapped confidence intervals to examine the indirect effect of narcissism on interpersonal problems via defensive style. Narcissism was significantly associated with immature and neurotic defensive styles. Although narcissism was not directly related to interpersonal problems, a significant indirect effect was observed for narcissism on interpersonal problems via neurotic defensive style. This finding suggests that narcissism contributes to the use of neurotic defenses, which in turn influence one's interpersonal functioning.
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42
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Hörz-Sagstetter S, Diamond D, Clarkin JF, Levy KN, Rentrop M, Fischer-Kern M, Cain NM, Doering S. Clinical Characteristics of Comorbid Narcissistic Personality Disorder in Patients With Borderline Personality Disorder. J Pers Disord 2018; 32:562-575. [PMID: 28758884 DOI: 10.1521/pedi_2017_31_306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study examines psychopathology and clinical characteristics of patients with borderline personality disorder (BPD) and comorbid narcissistic personality disorder (NPD) from two international randomized controlled trials. From a combined sample of 188 patients with BPD, 25 also fulfilled criteria for a comorbid diagnosis of NPD according to DSM-IV. The BPD patients with comorbid NPD, compared to the BPD patients without comorbid NPD, showed significantly more BPD criteria (M = 7.44 vs. M = 6.55, p < .001), fulfilled more criteria of comorbid histrionic (M = 3.84 vs. M = 1.98, p < .001), paranoid (M = 3.12 vs. M = 2.27, p = .014), and schizotypal (M = 1.64 vs. M = 1.02, p = .018) personality disorders, and were more likely to meet criteria for full histrionic PD diagnosis (44.0% vs. 14.2%, p < .001). The BPD-NPD group also reported significantly fewer psychiatric hospitalizations in the previous year (M = 0.40 vs. M = 0.82, p = .019) and fewer axis I disorders (M = 2.68 vs. M = 3.75, p = .033). No differences could be found in general functioning, self-harming behavior, and suicide attempts.
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Affiliation(s)
| | - Diana Diamond
- Department of Psychology, City University of New York.,Weill Cornell Medical College, New York, New York
| | | | - Kenneth N Levy
- Weill Cornell Medical College, New York, New York.,Pennsylvania State University
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43
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Klipfel KM, Kosson DS. The Relationship Between Grandiosity, Psychopathy, and Narcissism in an Offender Sample. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2018; 62:2687-2708. [PMID: 29121810 DOI: 10.1177/0306624x17734784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Clinical accounts suggest grandiosity is an important characteristic of both psychopathy and narcissism. This study examined the relationships between grandiosity and each of these personality disorder syndromes, using a novel index, namely the Grandiosity Index. Seventy-five incarcerated males completed clinical interviews of psychopathy and narcissism and a self-report inventory of narcissism and were rated on interpersonal measures of psychopathy and narcissism. Trained research assistants rated participants on the Grandiosity Index. Analyses provided preliminary evidence of construct validity for the index. Scores on the Grandiosity Index were significantly correlated with scores on both clinical and interpersonal measures of psychopathy and narcissism and with self-reported narcissism. Regressions demonstrated that the Grandiosity Index explained substantial unique variance in psychopathy after controlling for scores on narcissism. This study demonstrates that grandiose features are associated uniquely with clinical ratings of psychopathy, though not significantly more with psychopathy than with narcissism.
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Affiliation(s)
- Kristen M Klipfel
- 1 Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - David S Kosson
- 1 Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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Abstract
Few studies have examined associations between pathological narcissism and self-harm, but those that do indicate that narcissistic vulnerability (not narcissistic grandiosity) relates to self-harm. The current study extends this literature by investigating how facets of pathological narcissism assessed by the Pathological Narcissism Inventory relate to specific nonsuicidal self-injury (NSSI) behaviors assessed by the Inventory of Statements About Self-Injury using statistical models appropriate for non-normally distributed count data. In a sample of 1,023 undergraduate students, results revealed that facets of both narcissistic vulnerability and narcissistic grandiosity were differentially related to the endorsement and frequency of specific NSSI behaviors and higher-order latent NSSI factors (repetitive and impulsive), even after accounting for levels of borderline pathology. The clinical implications of these results are discussed.
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Affiliation(s)
- Sindes Dawood
- Pennsylvania State University, University Park, Pennsylvania
| | | | | | - Aaron L Pincus
- Pennsylvania State University, University Park, Pennsylvania
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45
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Keefe JR, Derubeis RJ. Changing character: A narrative review of personality change in psychotherapies for personality disorder. Psychother Res 2018; 29:752-769. [DOI: 10.1080/10503307.2018.1425930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- John R. Keefe
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert J. Derubeis
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
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46
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Gamache D, Savard C, Lemelin S, Côté A, Villeneuve E. Premature psychotherapy termination in an outpatient treatment program for personality disorders: a survival analysis. Compr Psychiatry 2018; 80:14-23. [PMID: 28915423 DOI: 10.1016/j.comppsych.2017.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/06/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Psychological treatment for patients with personality disorders (PD) is plagued with a high proportion of early dropouts, and attempts to identify risk factors for attrition have generated very few conclusive results. The purpose of the present study is to identify significant predictors of early treatment termination in a long-term psychotherapy program for PD. METHODS Data was retrospectively retrieved from 174 files of patients who began long-term psychotherapy in an outpatient treatment program in Quebec City, Canada. Socio-demographic, initial disturbance, and diagnostic variables were considered for prediction, along with a measure specifically designed to identify PD patients at risk of dropping out early from psychotherapy, the Treatment Attrition-Retention Scale for Personality Disorders (TARS-PD). Survival analysis using Cox proportional hazard regression was performed to identify significant predictors. RESULTS Results using univariate Cox proportional hazards regressions revealed that unemployment, Global Assessment of Functioning scores, and recent hetero-aggressive behavior were significant predictors of early dropout in the first six months of therapy. Adjusting for these three confounders, four of the factor scores from the TARS-PD (Narcissism, Secondary gains, Low distress, and Cluster A features) were significantly associated with dropout in univariate Cox proportional hazards regressions. Secondary gains and Narcissism remained significant predictors after entering all five TARS-PD factors in a multivariate Cox proportional hazards regression adjusting for confounders. CONCLUSIONS Taking into consideration specific treatment prognosis variables, such as those measured by the TARS-PD, might be more useful for dropout prediction in PD patients in comparison with more general demographic and diagnostic variables.
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Affiliation(s)
- Dominick Gamache
- Université du Québec à Trois-Rivières, Département de psychologie, C.P. 500, Trois-Rivières, QC, Canada; CERVO Research Center, 2601 Chemin de la Canardière, Quebec City, QC, Canada.
| | - Claudia Savard
- CERVO Research Center, 2601 Chemin de la Canardière, Quebec City, QC, Canada; Université Laval, Faculté des Sciences de l'éducation, 2325 rue des Bibliothèques, Quebec City, QC, Canada
| | - Sophie Lemelin
- Clinique Focus, 3679, rue de l'Hêtrière, Local 120, Saint-Augustin-de-Desmaures, QC, Canada
| | - Alexandre Côté
- Université du Québec à Trois-Rivières, Département de psychologie, C.P. 500, Trois-Rivières, QC, Canada
| | - Evens Villeneuve
- CERVO Research Center, 2601 Chemin de la Canardière, Quebec City, QC, Canada; Institut universitaire en santé mentale de Québec, Centre de traitement le Faubourg Saint-Jean, 2601 Chemin de la Canardière, Quebec City, QC, Canada
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Euler S, Stöbi D, Sowislo J, Ritzler F, Huber CG, Lang UE, Wrege J, Walter M. Grandiose and Vulnerable Narcissism in Borderline Personality Disorder. Psychopathology 2018; 51:110-121. [PMID: 29466803 DOI: 10.1159/000486601] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/16/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Little is known about narcissistic traits in borderline personality disorder (BPD). This exploratory study aimed to illustrate the associations between total, grandiose, and vulnerable narcissism and gender, diagnostic features of BPD and narcissistic personality disorder (NPD), and psychopathology in BPD patients. SAMPLING AND METHODS The Pathological Narcissism Inventory and psychometric measures for impulsivity, anger, borderline symptom severity, personality organization, depression, and rejection sensitivity were completed by 65 BPD patients. Statistical analyses were conducted using the t test, Pearson correlation, and multivariate regression analyses. RESULTS Male BPD patients displayed higher narcissistic scores than females (p < 0.01). Grandiose narcissism showed a stronger association with NPD than with BPD (p < 0.01) while vulnerable narcissism was only associated with BPD (p < 0.01). Rejection sensitivity (p < 0.01) and depression (p < 0.001) predicted vulnerable narcissism. CONCLUSION Vulnerable narcissism is closely associated with BPD and appears to be more dysfunctional than grandiose narcissism. A comprehensive consideration of both traits is recommended. Our results might help to generate hypotheses for further research on pathological narcissism in the spectrum of personality disorders. Future studies are advised to apply complementary measures and take new diagnostic approaches of DSM-5 and ICD-11 into account.
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Erkoreka L, Navarro B. Vulnerable narcissism is associated with severity of depressive symptoms in dysthymic patients. Psychiatry Res 2017; 257:265-269. [PMID: 28783573 DOI: 10.1016/j.psychres.2017.07.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/07/2017] [Accepted: 07/29/2017] [Indexed: 10/19/2022]
Abstract
Pathological narcissism involves grandiose and vulnerable presentations. Narcissism, and specifically the vulnerable presentation, has been associated to depression, although empirical research studying this relationship is limited. Dysthymia is characterized by a greater treatment resistance and poorer prognosis than other chronic depressive disorders. The presence of dysfunctional personality traits may explain it. We aim to explore the association between vulnerable narcissistic traits and severity of depressive symptoms in a sample of dysthymic patients. To that end, 80 dysthymic outpatients were evaluated. The treating psychiatrist collected sociodemographic and clinical data and completed the Clinical Global Impression-Severity Scale. Patients completed the Beck Depression Inventory (BDI) and the Hypersensitive Narcissism Scale (HSNS), that respectively assess severity of depressive symptoms and vulnerable narcissism. We tested for potential confounders and conducted a regression analysis to explore whether severity of vulnerable narcissism was associated with greater depressive symptoms. HSNS was found to be the principal predictor of BDI, and along with age, accounted for 23% of the variance in BDI. An assessment of personality functioning is therefore recommended in chronically depressed patients that have been refractory to standard treatments. Psychotherapies that address personality disturbance should be included in the treatment when necessary.
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Affiliation(s)
- Leire Erkoreka
- Barakaldo Mental Health Center, Mental Health Network of Biscay, Barakaldo, Spain; Dept. Neurosciences, University of the Basque Country UPV/EHU, Leioa, Spain; BioCruces Health Research Institute, Barakaldo, Spain.
| | - Bárbara Navarro
- Barakaldo Mental Health Center, Mental Health Network of Biscay, Barakaldo, Spain
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49
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Kealy D, Sandhu S, Ogrodniczuk JS. Looking ahead through a fragile lens: Vulnerable narcissism and the future self. Personal Ment Health 2017; 11:290-298. [PMID: 28749081 DOI: 10.1002/pmh.1384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 05/08/2017] [Accepted: 05/24/2017] [Indexed: 12/15/2022]
Abstract
Empirical data are lacking with regard to the degree to which self-absorbed hypersensitivity may be related to perceptions of the future self. The purpose of this study was to examine the relationship between vulnerable narcissism and several components of future orientation among psychiatric outpatients. A sample of 132 adult outpatients seeking mental health services completed measures assessing vulnerable narcissism, optimism, personal growth initiative and symptom distress, along with several questions regarding specific future outcomes. Correlation and regression analyses were used to examine relationships between vulnerable narcissism and future outlook domains, controlling for sociodemographic confounds and symptom distress. Significant negative associations were found between vulnerable narcissism and optimism, personal growth initiative, and expectations regarding mental health recovery and personal goal achievement. Clinical implications of these findings are discussed. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- David Kealy
- Department of Psychiatry, University of British Columbia, #420 - 5950 University Blvd., Vancouver, BC, V6T 1Z3, Canada
| | - Sharan Sandhu
- Surrey Mental Health and Substance Use Services, Fraser Health Authority, #1100 - 13401 108th Avenue, Surrey, BC, V3T 5T3, Canada
| | - John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, #420 - 5950 University Blvd., Vancouver, BC, V6T 1Z3, Canada
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50
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Abstract
Clinical observation has linked externalizing coping strategies such as substance overuse and aggressive behaviours with narcissistic personality dysfunction. This study examined the relationship between pathological narcissism and maladaptive self-regulatory behaviours among Canadian men. An online survey was distributed among a stratified, nationally representative sample of 1000 men from across Canada. The survey included brief self-report measures of pathological narcissism, maladaptive externalizing coping behaviours, and general psychological distress. After controlling for the effects of age and general psychological distress, pathological narcissism was found to be significantly associated with alcohol overuse and aggressive behaviour. Significant though modest interaction effects were found between pathological narcissism and age - with regards to drug use - and distress - with regards to risk-taking behaviour. The findings point to the need for attention to narcissistic dysfunction as a clinical and public health issue among men.
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