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Day NJS, Green A, Denmeade G, Bach B, Grenyer BFS. Narcissistic personality disorder in the ICD-11: Severity and trait profiles of grandiosity and vulnerability. J Clin Psychol 2024; 80:1917-1936. [PMID: 38742471 DOI: 10.1002/jclp.23701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/28/2024] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
Modern diagnostic and classification frameworks such as the ICD-11 and DSM-5-AMPD have adopted a dimensional approach to diagnosing personality disorder using a dual "severity" and "trait" model. As narcissistic personality has historically struggled to be adequately captured in dominant diagnostic systems, this study investigated the utility of the new ICD-11 framework in capturing diverse narcissistic expressions. Participants were mental health clinicians (N = 180, 67% female, age = 38.9), who completed ratings of ICD-11 personality severity, trait domains and a clinical reflection for two hypothetical case vignettes reflecting either prototypical "grandiose" or "vulnerable" narcissism. The majority of clinicians (82%) endorsed a diagnosis of personality disorder for both grandiose and vulnerable vignettes. Discriminant elements of personality impairment included rigid, unrealistically positive self-view, low empathy and high conflict with others for grandiosity, and incoherent identity, low self-esteem and hypervigilant, avoidant relations with others for vulnerability. Regarding trait profile, grandiose narcissism was predominately dissocial whereas vulnerable narcissism was primarily associated with negative affectivity and detachment. Qualitative responses highlight distinct clinical themes for each presentation. These findings suggest that clinicians using the ICD-11 framework are able to identify common core elements of personality dysfunction in grandiose and vulnerable narcissism while also recognizing their distinctive differences.
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Affiliation(s)
- Nicholas J S Day
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Ava Green
- Department of Psychology, City, University of London, London, UK
| | - Georgia Denmeade
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Bo Bach
- Psychiatric Research Unit, Mental Health Services, Center for Personality Disorder Research, Region Zealand, Denmark
| | - Brin F S Grenyer
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
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2
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Vaysi A, Nazarpour P, Kiani Z, Maleki M, Hamzehei M, Amianto F, Sellbom M, Komasi S. Replicability of the five-factor structure of DSM-5 and ICD-11 trait systems and their associations with binge eating and bipolar spectrum psychopathology. Personal Ment Health 2024; 18:122-137. [PMID: 38031321 DOI: 10.1002/pmh.1600] [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: 08/17/2023] [Revised: 10/21/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023]
Abstract
Since the research on contemporary personality models-and psychopathology-mainly originate from the Western world, we aimed to test the factorial structure of two trait systems assessed with the Personality Inventory for DSM-5 (PID-5) in a non-Western sample and to compare the extracted models' relative associations with binge eating disorder (BED) and bipolar spectrum disorder (BSD) symptoms. A community sample (N = 516; 72% female) was administered the PID-5, which can operationalize both the DSM-5 and ICD-11 systems. The factor structures of both systems were tested using exploratory structural equation modeling (ESEM). The congruence coefficients of all factor loadings with international studies were calculated. The Binge Eating Scale (BES), Bipolar Spectrum Diagnostic Scale (BSDS), and Hypomania Checklist-32-Revised (HCL-32) were used to measure the criterion variables. Linear regression models were used for comparing the DSM-5 and ICD-11 systems in predicting the BED and BSD. The findings supported five-factor solutions for both trait systems. Both systems significantly predicted dimensional measures of both BED and BSD (all p < 0.001). The present findings support an acceptable five-factor structure for both personality systems in the non-Western sample. Different algorithms of maladaptive domains on both systems are related to binge eating and bipolar spectrum psychopathology.
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Affiliation(s)
- Anis Vaysi
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Parisa Nazarpour
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Zhaleh Kiani
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Mahtab Maleki
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Maryam Hamzehei
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
| | - Federico Amianto
- Department of Neurosciences, Psychiatry Section, Regional Pilot Centre for Eating Disorders, University of Torino, Torino, Italy
| | - Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Saeid Komasi
- Department of Neuroscience and Psychopathology Research, Mind GPS Institute, Kermanshah, Iran
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3
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Runcan R, Rad D, Runcan P, Măduța C. A Network Analysis Approach toward Adaptive Overt Narcissism Network. Behav Sci (Basel) 2023; 13:468. [PMID: 37366722 DOI: 10.3390/bs13060468] [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: 04/13/2023] [Revised: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
The relationship between narcissistic personality and art and beauty appreciation has recently become the focus of research investigations. Adaptive narcissists raise their sense of worth in order to shield themselves from harm caused by others. Because they aspire to be more attractive, healthier, and successful versions of themselves, they frequently have greater success in life than the majority of people. Grandiose and overtly narcissistic behavior are the main recognized characteristics of an overt narcissist, which is currently regarded as a personality disorder that puts mental health and wellbeing at peril. On a random sample collection of data from 1101 respondents to an online questionnaire, we conducted a network analysis of the Adaptive Overt Narcissism Scale (AONS) items. In this study, we used a network analysis approach to examine the network structure of adaptive overt narcissism, as well as its relationships with psychological functioning. The present study utilized network analysis to investigate the centrality measures of items in the Adaptive Overt Narcissism Scale (AONS) and their interrelationships. Results indicated that item Q6.8 ("I appreciate art and beauty") had low betweenness, closeness, and strength centrality measures, indicating that it was less influential in the network. However, it also had negative expected influence, suggesting that its absence would have a destabilizing effect on the network. These results highlight the importance of the appreciation of art and beauty in deactivating the adaptive overt narcissist network. Further research is needed to explore the mechanisms underlying this relationship and its implications for narcissism prevention and intervention.
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Affiliation(s)
- Remus Runcan
- Center of Research Development and Innovation in Psychology, Faculty of Educational Sciences Psychology and Social Work, Aurel Vlaicu University of Arad, 310032 Arad, Romania
| | - Dana Rad
- Center of Research Development and Innovation in Psychology, Faculty of Educational Sciences Psychology and Social Work, Aurel Vlaicu University of Arad, 310032 Arad, Romania
| | - Patricia Runcan
- Department of Social Work, Faculty of Sociology and Psychology, West University of Timişoara, 300223 Timișoara, Romania
| | - Cristian Măduța
- Faculty of Humanities and Social Sciences, Aurel Vlaicu University of Arad, 310032 Arad, Romania
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4
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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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5
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Barahmand U, Shamsina N, Rojas K, Geschwind N, Haruna Iya F. Mechanisms Linking Perfectionism and Social Anxiety: The Role of Hostility and Disqualification of Positive Social Outcomes. J Psychiatr Pract 2023; 29:94-103. [PMID: 36928196 DOI: 10.1097/pra.0000000000000700] [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: 03/18/2023]
Abstract
While considerable research has focused on maladaptive perfectionism as a risk factor for social anxiety, little attention has been given to the mechanisms that mediate the effects. We integrated perfectionism with the bivalent fear of evaluation model of social anxiety to investigate 2 hypothesized mechanisms: hostile attribution bias and disqualification of positive social outcomes (DPSO). Specifically, we hypothesized that individuals with maladaptive perfectionism develop hostile attribution biases which then lead to DPSO, which in turn predisposes them to social anxiety. Participants were 242 individuals from the general population who completed measures of perfectionism, hostile attribution bias, DPSO, and social anxiety. A test of multiple mediators using bootstrapping supported the hypothesized multiple mediator models. The results suggested that maladaptive perfectionism predisposes an individual to social anxiety through hostile attribution bias and DPSO. The results further suggested that DPSO but not hostile attribution bias operates as an individual mediator in the perfectionism-social anxiety relationship. The findings from this study provide support for the bivalent fear of evaluation model of social anxiety; however, the use of a cross-sectional design limited our ability to find true cause-and-effect relationships.
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Affiliation(s)
- Usha Barahmand
- BARAHMAND, SHAMSINA, ROJAS, GESCHWIND, IYA: Queens College, City University of New York, New York, NY
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6
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Enikolopov SN, Vorontsova OY, Medvedeva TI, Boyko OM, Oleichik IV. [Hostility as a manifestation of attachment disorders in depression]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:79-84. [PMID: 38127705 DOI: 10.17116/jnevro202312311279] [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: 12/23/2023]
Abstract
OBJECTIVE To analyze the relationship between hostility and attachment disorders in endogenous depression. MATERIAL AND METHODS The study included 49 patients with a diagnosis of depressive disorder, all of them completed the Simptom Check List-90-Revised (SCL-90R); the Buss-Perry Aggression Questionnaire; the Experiences in Close Relationships-Revised (ECR-R); Ich-Struktur-Test nach Ammon. The patients were assessed using the Hamilton Depression Rating Scale (HDRS-17). RESULTS At high levels of depression, the indicators of «hostility» (p=0.046), «destructive aggression» (p=0.04) and «deficit aggression» (p=0.005) are significantly higher. The severity of depression significantly correlates with the severity of «anxiety» in attachment (close relationships), as well as with pathological «narcissism», «destructive external self-delimitation», «deficient internal self-delimitation» (p<0.05). For the measure of depression, the regression model explains more than 76% of the variance, with the measures of «interpersonal sensitivity», «deficit narcissism», and «avoidance» in attachment making significant contributions. For the «hostility» the regression model explains about 62% of the variance, while, as in the analysis of «depression», a significant contribution is made by the indicators of «interpersonal sensitivity» and «avoidance», however, unlike «depression», the contribution of the «destructive narcissism» is noted in contrast to the «deficit narcissism». CONCLUSIONS With severe depressive symptoms, indicator of hostility are increased. Hostility in depression is associated with factors caused by a violation of early interpersonal relationships (anxious attachment) (which causes increased sensitivity in relations with others, building a barrier between oneself and the external environment perceived as hostile), the narcissistic pathology, problems in emotional regulation.
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Affiliation(s)
| | | | | | - O M Boyko
- Mental Health Research Center, Moscow, Russia
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7
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Simon J, Lambrecht B, Bach B. Cross-walking personality disorder types to ICD-11 trait domains: An overview of current findings. Front Psychiatry 2023; 14:1175425. [PMID: 37091704 PMCID: PMC10116048 DOI: 10.3389/fpsyt.2023.1175425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/16/2023] [Indexed: 04/25/2023] Open
Abstract
The ICD-11 has adopted a classification of Personality Disorders (PD) that abolishes the established categorical PD types in favor of global severity classification with specification of individual trait domains. To facilitate and guide this profound transition, an overview of current research on empirical associations between established PD types and ICD-11 trait domains seems warranted. We identified a total of 9 relevant studies from 2018 to 2022, which were based on both clinical and community samples from U.S., China, Brazil, Denmark, Spain, Korea, and Canada. The patterns of associations with ICD-11 trait domains were systematically synthesized and portrayed for each PD type. Findings overall showed expected and conceptually meaningful associations between categorical PD types and ICD-11 trait domains, with only few deviations. Based on these findings, we propose a cross-walk for translating categorical PD types into ICD-11 trait domains. More research is needed in order to further guide continuity and translation between ICD-10 and ICD-11 PD classification in mental healthcare, including facet-level ICD-11 trait information. Moreover, the nine reviewed studies only relied on self-reported ICD-11 trait domains, which should be expanded with clinician-rated trait domains in future research. Finally, future research should also take ICD-11's essential PD severity classification into account.
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Affiliation(s)
- Jonatan Simon
- Center for Personality Disorder Research (CPDR), Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Bastian Lambrecht
- Center for Personality Disorder Research (CPDR), Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Bo Bach
- Center for Personality Disorder Research (CPDR), Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- *Correspondence: Bo Bach,
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8
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Théberge D, Gamache D. An Appraisal of Narcissistic Rage Through Path Modeling. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:NP796-NP818. [PMID: 35334202 PMCID: PMC9709537 DOI: 10.1177/08862605221084746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Pathological narcissism and borderline traits have been consistently associated with interpersonal aggression. Shame has been identified as an important trigger of aggressive behaviors in individuals with pathological personality traits, especially for narcissistic vulnerability and borderline traits. This is in line with Kohut's theory on narcissistic rage, that is, aggression, anger, and destruction that act as a protection for a grandiose self. The present study aims to investigate the interrelations between pathological narcissism, borderline traits, shame, and trait aggression, concepts that are parts of the narcissistic rage phenomenon introduced by Kohut, using path models. A total of 399 participants completed self-report questionnaires assessing personality traits (narcissistic grandiosity and vulnerability, and borderline traits), shame, and aggression. Three path models including these variables were tested and compared to one another on fit indices. Results show that shame acts as a mediator between pathological traits (narcissistic vulnerability and borderline traits) and trait aggression, whereas the relationship between narcissistic grandiosity and aggression was direct (i.e., shame was not involved). Results expand the narcissistic rage theory by suggesting that it might represent an internalizing type of aggression that manifests in the context of narcissistic vulnerability and borderline traits, which is not the case for narcissistic grandiosity that exerts a direct effect on trait aggression.
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Affiliation(s)
- David Théberge
- Department of Psychology,
Université
du Québec à Trois-Rivières, QC,
Canada
| | - Dominick Gamache
- Department of Psychology,
Université
du Québec à Trois-Rivières, QC,
Canada
- CERVO Brain Research Centre,
Université Laval, Quebec City, QC, Canada
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9
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Bach B, Kramer U, Doering S, di Giacomo E, Hutsebaut J, Kaera A, De Panfilis C, Schmahl C, Swales M, Taubner S, Renneberg B. The ICD-11 classification of personality disorders: a European perspective on challenges and opportunities. Borderline Personal Disord Emot Dysregul 2022; 9:12. [PMID: 35361271 PMCID: PMC8973542 DOI: 10.1186/s40479-022-00182-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/11/2022] [Indexed: 12/05/2022] Open
Abstract
The 11th revision of the World Health Organization (WHO) International Classification of Diseases (ICD-11) includes a fundamentally new approach to Personality Disorders (PD). ICD-11 is expected to be implemented first in European countries before other WHO member states. The present paper provides an overview of this new ICD-11 model including PD severity classification, trait domain specifiers, and the additional borderline pattern specifier. We discuss the perceived challenges and opportunities of using the ICD-11 approach with particular focus on its continuity and discontinuity with familiar PD categories such as avoidant PD and narcissistic PD. The advent of the ICD-11 PD classification involves major changes for health care workers, researchers, administrators, and service providers as well as patients and families involved. The anticipated challenges and opportunities are put forward in terms of specific unanswered questions. It is our hope that these questions will stimulate further research and discussion among researchers and clinicians in the coming years.
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Affiliation(s)
- Bo Bach
- Center for Personality Disorder Research, Slagelse Psychiatric Hospital, Region Zealand, Slagelse, Denmark
| | - Ueli Kramer
- Institute of Psychotherapy/General Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephan Doering
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Ester di Giacomo
- School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Joost Hutsebaut
- Viersprong Institute for Studies on Personality Disorders, Halsteren, Netherlands
| | - Andres Kaera
- Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Chiara De Panfilis
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | | | - Svenja Taubner
- Institute for Psychosocial Prevention, University Heidelberg, Heidelberg, Germany
| | - Babette Renneberg
- Clinical Psychology and Psychotherapy, Freie Universität, Habelschwerdter Allee 45, 14195, Berlin, Germany.
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Alremawi S, Arabiyat AA. The Effectiveness of a Behavioral Program in Reducing the Aggressive Behavior of Children with Mild Mental Disabilities at the Mu’tah Center for Special Education. Health Psychol Res 2022; 10:32317. [DOI: 10.52965/001c.32317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sameer Alremawi
- Department of Psychology and special education, Al-Balqa Applied University
| | - Ahmed A. Arabiyat
- Department of Psychology and special education, Al-Balqa Applied University
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11
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Flett GL, Hewitt PL, Nepon T, Sherry SB, Smith M. The destructiveness and public health significance of socially prescribed perfectionism: A review, analysis, and conceptual extension. Clin Psychol Rev 2022; 93:102130. [DOI: 10.1016/j.cpr.2022.102130] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 01/18/2022] [Accepted: 01/23/2022] [Indexed: 11/16/2022]
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12
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Riegel KD, Schlosserova L, Zbornik TS. Self-reported narcissistic traits in patients with addiction through the lens of the ICD-11 model for personality disorders. Front Psychiatry 2022; 13:1041480. [PMID: 36506455 PMCID: PMC9732545 DOI: 10.3389/fpsyt.2022.1041480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There is a presumption that pathological narcissism, or narcissistic personality disorder per se, can be considered a precursor to addiction. Although the ICD-11 model does not distinguish specific personality disorders, narcissistic psychopathology should be captured through personality trait qualifiers. OBJECTIVES To verify the capacity of the ICD-11 model in the detection of narcissistic psychopathology in patients with addiction; to test its discrimination capacity, convergent validity, and specificity toward the gender and the type of addiction. MATERIALS AND METHODS Two samples were employed in the study. Sample 1 (n = 421) consisted of patients with addiction; Sample 2 (n = 567) consisted of general population volunteers. Age range was 18-75 years and a battery of self-assessment questionnaires containing Personality Inventory for DSM-5-Brief Form Plus Modified; Triarchic Psychopathy Measure; Hypersensitive Narcissism Scale; and Level of Personality Functioning Scale-Self-Report was administered by pencil-and-paper method. RESULTS The following was confirmed: (1) capacity of the ICD-11 model in relation to capture narcissistic pathology; (2) the differentiation capacity between the clinical and non-clinical population; (3) gender specificity in relation to grandiose and vulnerable narcissism; (4) the connection between the overall degree of impairment in personality functioning and most of trait qualifiers; (5) certain specifics of patients with addiction in relation to the type of addiction. CONCLUSION Results support the empirical and clinical relevance of the ICD-11 model in capturing narcissistic pathology in addicted patients. Clinical implications concerning assessment and treatment in addiction settings, and certain limits regarding the Anankastia domain are discussed.
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Affiliation(s)
- Karel D Riegel
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Lucia Schlosserova
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Tadeas S Zbornik
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
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Schalkwijk F, Luyten P, Ingenhoven T, Dekker J. Narcissistic Personality Disorder: Are Psychodynamic Theories and the Alternative DSM-5 Model for Personality Disorders Finally Going to Meet? Front Psychol 2021; 12:676733. [PMID: 34335390 PMCID: PMC8321510 DOI: 10.3389/fpsyg.2021.676733] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022] Open
Abstract
Narcissistic Personality Disorder is the new borderline personality disorder of our current era. There have been recent developments on narcissism that are certainly worthwhile examining. Firstly, relational and intersubjective psychoanalysts have been rethinking the underlying concepts of narcissism, focusing on the development of self and relations to others. Secondly, in the DSM-5, the Alternative DSM-5 Model for Personality Disorders (AMPD) was presented for a dimensional evaluation of the severity of personality disorder pathology. The combined dimensional and trait conceptualization of NPD opened the door to new integrated diagnostic perspectives, including both internal and interpersonal functioning. Finally, Pincus and Lukowitsky encourage clinicians to use a hierarchical model of pathological narcissism, as it opens up opportunities for shared points of interest in empirical research from different scholarly perspectives. As for most non-psychodynamic clinicians and researchers the DSM-5 clearly bears dominant weight in their work, we will take the AMPD model for NPD as our point of reference. We will discuss the narcissist's unique pattern of self-impairments in identity and self-direction, and of interpersonal disfunctioning (evaluated by assessing empathy and intimacy). Subsequently, we will examine how contemporary psychodynamic theories and the hierarchical model of Pincus and Lukowitsky additionally inform or contradict the AMPD. For us, one of the big advantages of the AMPD is the use of structured clinical evaluations of disturbances of the self and interpersonal functioning and the dimensional evaluation of severity. As psychodynamically oriented therapists, we are enthusiastic about the opportunities for inclusion of psychodynamic concepts, but we also discuss a number of sticking points.
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Affiliation(s)
- Frans Schalkwijk
- Department of Forensic Special Education, University of Amsterdam, Amsterdam, Netherlands
| | - Patrick Luyten
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom.,KU Leuven, Leuven, Belgium
| | | | - Jack Dekker
- Arkin, Amsterdam, Netherlands.,Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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14
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Hemmati A, Rahmani F, Bach B. The ICD-11 Personality Disorder Trait Model Fits the Kurdish Population Better Than the DSM-5 Trait Model. Front Psychiatry 2021; 12:635813. [PMID: 33859581 PMCID: PMC8042144 DOI: 10.3389/fpsyt.2021.635813] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
The ICD-11 Classification of Personality Disorders and the DSM-5 Alternative Model of Personality Disorders (AMPD) operate with trait domains that contribute to the individual expression of personality disturbance (i.e., negative affectivity, detachment, dissociality, disinhibition, anankastia, and psychoticism). To date, these trait frameworks have not been investigated sufficiently in Middle Eastern cultures. Thus, the present study explored the structure of the ICD-11 and AMPD personality disorder (PD) trait domains in a large mixed sample from the Kurdistan zone of Iran. The ICD-11 and AMPD trait domains were operationalized using empirically supported algorithms for the Personality Inventory for DSM-5 (PID-5). The PID-5 was administered to a large mixed sample (N = 3,196) composed of 2,678 community and 518 clinical participants. Structural validity was investigated using Exploratory Factor Analysis (EFA), whereas differential construct validity was explored by comparing clinical and community scores. Model fit and the expected factor structure were deemed appropriate for the ICD-11 trait model, but less adequate for the DSM-5 trait model (i.e., disinhibition did not emerge as a separate factor). All domain and facet scores showed significant differences between clinical and community subsamples with moderate to large effects, mostly for disinhibition and dissociality/antagonism while least for anankastia. The findings of the present study may suggest that the ICD-11 trait model is more cross-culturally fitting than the DSM-5 AMPD trait model, at least with respect to a large mixed sample from the region of Kurdistan. Accordingly, there is evidence for using PID-5 data for WHO ICD-11 purposes in this part of the World.
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Affiliation(s)
- Azad Hemmati
- Department of Psychology, University of Kurdistan, Sanandaj, Iran
| | - Fateh Rahmani
- Department of Psychology, University of Kurdistan, Sanandaj, Iran
| | - Bo Bach
- Psychiatric Research Unit, Center for Personality Disorder Research, Region Zealand Psychiatry, Slagelse, Denmark
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