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Duarte M, Blay M, Hasler R, Pham E, Nicastro R, Jan M, Debbané M, Perroud N. Adult ADHD and pathological narcissism: A retrospective-analysis. J Psychiatr Res 2024; 174:245-253. [PMID: 38670059 DOI: 10.1016/j.jpsychires.2024.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 03/14/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
Adult attention deficit hyperactivity disorder (ADHD) is often associated with personality pathology. However, only few studies have been conducted on the link between ADHD and pathological narcissism (PN), with or without a diagnosis of narcissistic personality disorder (NPD). In order to fill this gap, PN and NPD were assessed in 164 subjects suffering from ADHD, with several other measures including ADHD severity, quality of life, depression, anxiety, impulsivity, and emotion dysregulation (ED). We found that a significant proportion of ADHD patients suffered from NPD, and that both narcissistic grandiosity and vulnerability were associated with ADHD hyperactivity and impulsivity symptoms, but not with inattentive symptoms. These two dimensions seemed to be negatively associated with well-being and positively associated with most of the other studied psychiatric dimensions except ED, the latter being only associated with vulnerability, even after adjustment on borderline symptoms. Overall, despite important limitations that limit the generalizability of our findings to the overall ADHD population (notably linked to selection bias), we believe that this exploratory study sheds light on the potential clinical relevance of narcissistic pathology in adult ADHD patients.
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Affiliation(s)
- Miguel Duarte
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Martin Blay
- ADDIPSY, Centre Ambulatoire d'Addictologie et de Psychiatrie, Groupe Santé Basque Développement, Lyon, France; Université Paris-Saclay, UVSQ, INSERM, Centre de recherche en Epidémiologie et Santé des Populations Team "DevPsy", 94807, Villejuif, France.
| | - Roland Hasler
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Eleonore Pham
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Rosetta Nicastro
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Marlène Jan
- Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Le Chesnay, France
| | - Martin Debbané
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland; Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom
| | - Nader Perroud
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
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Dimaggio G, Weinberg I. What do we need in order to successfully treat persons with pathological narcissism? How does change happen? Treatment principles and mechanisms of change emerging from single cases treated by experts: A commentary. J Clin Psychol 2024; 80:1079-1097. [PMID: 38308855 DOI: 10.1002/jclp.23652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/21/2024] [Indexed: 02/05/2024]
Abstract
Persons with pathological narcissism (PN) or narcissistic personality disorder present with a wide array of symptoms and social problems. They need effective psychotherapies but empirical evidence for what works with them is mostly lacking. In this issue of the Journal and Clinical Psychology: In Session four authors from different orientations described single cases of patients suffering from different manifestations of PN. In this commentary we reviewed in detail the four cases and tried to distill (a) the treatment principles adopted; (b) the actual mechanisms of therapeutic change. We hope that the list of principles and mechanisms and change we identified here can help both clinicians and researchers develop and test effective options for persons with PN who are difficult to treat but do have chances to change in a meaningful way in treatment.
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Hinz LD. Filling the form: Expressive Therapies Continuum-guided treatment of narcissistic personality disorder. J Clin Psychol 2024; 80:1192-1206. [PMID: 38178697 DOI: 10.1002/jclp.23635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 11/08/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024]
Abstract
Sara was a 65-year-old Caucasian woman who requested art therapy after the death of her partner. She had experienced incest by her father and verbal abuse by her mother until she left home at 21. Her life was characterized by broken relationships due to alienating anger outbursts and an interrupted work history; she met three criteria for narcissistic personality disorder. Sara initially was socially isolated and intellectualizing. She desired recognition but was fearful of exposure. The Expressive Therapies Continuum (ETC) theoretical framework, which consisted of a gradual progression from cognitively-dominated sessions to more emotionally focused processing, guided the therapeutic work. The ETC theory encourages transparency and collaboration between therapist and client regarding therapeutic tasks and goals, and provides a framework for addressing and repairing ruptures in the therapeutic alliance. Art therapy began with the cognitive tasks which Sara completed relatively comfortably, then encouraged integration of emotion via expressive writing, diagrams, and body mapping. Through careful attention to repair of ruptures by directly discussing and adapting the direction and tasks of therapy, Sara slowly was able to experience emotions other than anger. She integrated cognitive and emotional insights about her life and developed empathy for her childhood self. At termination Sara had cultivated two friendships and met only one criterion of NPD. Limitations of this case study include a lack of research evidence for ETC-guided art therapy with NPD clients and by the retrospective approach. Future research efforts could provide this support by encouraging clinicians to conduct prospective case study research.
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Affiliation(s)
- Lisa D Hinz
- Department of Art Therapy Psychology, Dominiacan University of California, San Rafael, California, USA
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Magistrale G, Hasson-Ohayon I, Lysaker PH, Dimaggio G. Homework assignments in relational psychoanalytic treatment of personality disorders: A case study of a patient with narcissistic personality disorder. J Clin Psychol 2024; 80:871-883. [PMID: 37847856 DOI: 10.1002/jclp.23600] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/30/2023] [Accepted: 09/23/2023] [Indexed: 10/19/2023]
Abstract
Homework assignments, or specific tasks patients are asked to engage in or complete between sessions, are a controversial topic among psychoanalysts. While many argue these interventions contradict psychoanalytic principles, others believe they can help address problems and promote coping skills. We propose that homework can be a legitimate aspect of relational psychoanalysis when used in a way that is attuned to the patient's experience and that homework may be an important component of treating personality disorders (PD). We present the case of a man diagnosed with narcissistic PD. He often felt superior to and reported that he despised others, though the core self-image was of fragile. He embraced the role of the omnipotent caregiver, which came with boredom and anger and lack of satisfaction in his social life. The patient tried to control therapy, asserting that he could psychoanalyze himself. As a result, therapy was stalled and progress was limited. At this point, the therapist asked him to complete homework assignments that encouraged him to refrain from his compulsive caregiving to better understand what motivated this behavior. Through this process, the patient came to realize he acted out of avoidance, as he did not want to disclose his own vulnerabilities and flaws. At that point he was able to experience relationships while adopting different stances and finding new meanings. We argue that homework can be fully integrated into the relational psychoanalytic repertoire to improve self-reflection and foster change in patients with PD.
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Affiliation(s)
| | | | - Paul H Lysaker
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
- Department of Psychiatry, Indiana Univeristy School of Medicine, Indianapolis, Indiana, USA
| | - Giancarlo Dimaggio
- Centro di Terapia Metacognitiva Interpersonale, Piazza dei Martiri di Belfiore 4, Rome, Italy
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Weinberg I. Building hope for treatment of narcissistic personality disorder. J Clin Psychol 2024; 80:721-732. [PMID: 37815416 DOI: 10.1002/jclp.23598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/30/2023] [Accepted: 09/14/2023] [Indexed: 10/11/2023]
Affiliation(s)
- Igor Weinberg
- Gunderson Personality Disorder Institute, McLean Hospital, Belmont, Massachusetts, USA
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Kealy D, Gazzillo F. Testing and treatment-by-attitude in psychotherapy for pathological narcissism: A clinical illustration. J Clin Psychol 2024; 80:795-808. [PMID: 38009529 DOI: 10.1002/jclp.23625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/16/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
Pathological narcissism is a personality constellation comprising distorted self-image, maladaptive self-esteem regulation, and difficulties in intimate relationships. Patients with elevated pathological narcissism may not necessarily meet criteria for narcissistic personality disorder, and may seek treatment for a range of mental health concerns across various clinical settings. An understanding of key principles of control-mastery theory (CMT) can help clinicians understand the specific goals and challenges of the individual patient with pathological narcissism, and can illuminate ways in which the patient may work in psychotherapy. This paper outlines how patients with pathological narcissism may engage in testing of their pathogenic beliefs, and how therapists can respond in ways that facilitate the patient's sense of safety and foster psychological work. The role of the therapist's attitude is highlighted as a means for countering pathogenic beliefs associated with pathological narcissism. Clinical material from a single case of time-limited supportive psychotherapy will be used to illustrate these principles and associated therapeutic processes. Insights from CMT regarding pathogenic beliefs and the patient's plan for addressing them can help to explain how therapy works or does not work for patients with pathological narcissism.
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Affiliation(s)
- David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Francesco Gazzillo
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
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Dimaggio G, Valentino V. The ongoing rewriting of the therapeutic contract in Metacognitive Interpersonal Therapy for narcissistic personality disorder: The case of Mark. J Clin Psychol 2024; 80:776-794. [PMID: 37965788 DOI: 10.1002/jclp.23621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023]
Abstract
In order to effectively treat individuals suffering from Narcissistic Personality Disorder (NPD), it is crucial to establish therapeutic goals and identify tasks to achieve them. However, this is a challenging process with NPD patients because they often struggle to find meaningful goals beyond the pursuit of status. Moreover, in order to change Furthermore, to promote change, they must confront painful emotions such as shame, guilt, or fear, which they habitually try to avoid. Additionally, they face difficulties in forming a positive perception of their therapists and cooperating towards mutually agreed-upon goals and tasks. As a consequence, NPD patients ask for change but hardly engage themselves in the work necessary to achieve it. Therapists therefore need to pay the uttermost attention to drafting, negotiating and continuously updating a reasonable and realistic therapeutic contract. In this paper we describe the story of a man in his thirties with NPD who was ridden with depression, guilt, envy and anger and did not find ways to pursue the healthy and adaptive behaviors he would need to pursue in order to leave a richer social life. The therapist overcame ruptures in the therapeutic alliance and then involved the patient in a process where they set the steps to follow, making sure the patient was convinced they made sense. After a contract was reached progress became possible. Implications for the role of the therapeutic contract in NPD treatment are discussed.
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Wallace HM, Carrillo A, Kelley J. Perceptions of narcissism in college professors. J Soc Psychol 2024; 164:169-186. [PMID: 35311480 DOI: 10.1080/00224545.2022.2050167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
Abstract
We conducted three studies to examine perceptions of grandiose narcissism in college professors. Narcissism might appear incompatible with the profession if professors are viewed fundamentally as helpers or as introverted bookworms. Then again, people might expect professors to display big egos congruent with the prestige of their profession and their privileged public platforms. Our research indicates that professors are generally not seen as highly narcissistic according to the criteria of the Narcissistic Personality Inventory and the Narcissistic Admiration and Rivalry Questionnaire, though they are viewed as more narcissistic than elementary school teachers. More professor narcissism was expected at colleges that prioritize scholarly productivity over teaching excellence. Male professors were viewed as more narcissistic, but only for narcissism dimensions associated with interpersonal hostility and for judgments of whether professors are "narcissistic." We discuss possible implications for narcissistic professors' ability to exploit the gap between academic ideals and reward system realities.
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Freudenthaler L, Eher R. [Relations Between Rape Myths and Behavioral and Personality Characteristics in Males Convicted of Rape]. Psychother Psychosom Med Psychol 2024; 74:85-93. [PMID: 38316437 DOI: 10.1055/a-2235-9399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To date the relationships between rape myths and other psychological constructs within males who have committed rape have not been explored sufficiently. Considered as a risk factor for the perpetration of rape it seems significant to examine their association to individual behavioral and personality characteristics more in detail. METHODS Therefore, we analyzed the relations between self-reported rape myth acceptance and the self-evaluation of aggressiveness, assertiveness, hypersexuality, social anxiety, sexual anxiety, SCID personality characteristics and the external assessment of psychopathy within a sample of N=569 males convicted of rape. RESULTS The results showed significant correlations with all constructs except sexual anxiety, antisocial personality and psychopathy. Furthermore, findings indicated the assignment of the relevant variables to two principal components: rape myths, aggressiveness, hypersexuality, paranoid and narcissistic personality (K1) on the one hand and psychopathy and antisocial personality (K2) on the other hand. DISCUSSION Following the results, rape myths are contextualized within the investigated psychological constructs and their potential differentiation from psychopathy and antisocial personality is discussed.
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Affiliation(s)
- Laura Freudenthaler
- Begutachtungs- und Evaluationsstelle für Gewalt- und Sexualstraftäter (BEST), Österreichisches Bundesministerium für Justiz, Wien, Österreich
| | - Reinhard Eher
- Begutachtungs- und Evaluationsstelle für Gewalt- und Sexualstraftäter (BEST), Österreichisches Bundesministerium für Justiz, Wien, Österreich
- Abteilung für Forensische Psychiatrie und Psychotherapie, Universität Ulm, Deutschland
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Sabuncuoglu O. A Rebuttal To Psychoanalytic Biography Of Mustafa Kemal Atatürk. Acta Med Hist Adriat 2024; 21:203-222. [PMID: 38270074 DOI: 10.31952/amha.21.2.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Mustafa Kemal Atatürk (1881-1938) was the founder of the modern-day Turkish Republic. Although much has been published about his life, only one biography adopted a psychological/psychoanalytic perspective. The authors Vamık Volkan and Norman Itzkowitz argued that the main driving mechanism behind Atatürk's behavior was his narcissistic personality organization. Their framework considered Mustafa's birth, which occurred shortly after his elder brothers had passed away, and how his mother, presumably in a state of severe depression, could not provide adequate emotional care, which gave way to compensatory narcissistic tendencies in the child. For several decades, the hypothesis has remained unchallenged, and no serious review has yet been carried out. In this article, I argue that Mustafa Kemal was a highly intelligent and gifted child based on his well-developed verbal skills and his record as a high achiever at school. While considering the impact of adverse events in early childhood on cognitive development and personality, a review of historical texts revealed that his elder brothers died in 1883-not before Mustafa's birth, as the authors had believed. Thus, no serious event appears to have taken place in his early years when rapid brain development is thought to occur. Since the central premise has lost its integrity to support the biography, Volkan and Itzkowitz's hypothesis can no longer be regarded as tenable and viable.
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Affiliation(s)
- Osman Sabuncuoglu
- Department of Child and Adolescent Psychiatry, Marmara University School of Medicine, Istanbul, Turkey
E-mail:
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Michelutti M, Urso D, Gnoni V, Giugno A, Zecca C, Vilella D, Accadia M, Barone R, Dell'Abate MT, De Blasi R, Manganotti P, Logroscino G. Narcissistic Personality Disorder as Prodromal Feature of Early-Onset, GRN-Positive bvFTD: A Case Report. J Alzheimers Dis 2024; 98:425-432. [PMID: 38393901 DOI: 10.3233/jad-230779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Background Behavioral variant frontotemporal dementia (bvFTD) typically involves subtle changes in personality that can delay a timely diagnosis. Objective Here, we report the case of a patient diagnosed of GRN-positive bvFTD at the age of 52 presenting with a 7-year history of narcissistic personality disorder, accordingly to DSM-5 criteria. Methods The patient was referred to neurological and neuropsychological examination. She underwent 3 Tesla magnetic resonance imaging (MRI) and genetic studies. Results The neuropsychological examination revealed profound deficits in all cognitive domains and 3T brain MRI showed marked fronto-temporal atrophy. A mutation in the GRN gene further confirmed the diagnosis. Conclusions The present case documents an unusual onset of bvFTD and highlights the problematic nature of the differential diagnosis between prodromal psychiatric features of the disease and primary psychiatric disorders. Early recognition and diagnosis of bvFTD can lead to appropriate management and support for patients and their families. This case highlights the importance of considering neurodegenerative diseases, such as bvFTD, in the differential diagnosis of psychiatric disorders, especially when exacerbations of behavioral traits manifest in adults.
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Affiliation(s)
- Marco Michelutti
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G.Panico", Tricase, Italy
- Department of Medicine, Surgery and Health Sciences, Clinical Unit of Neurology, University Hospital of Trieste, University of Trieste, Trieste, Italy
| | - Daniele Urso
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G.Panico", Tricase, Italy
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Valentina Gnoni
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G.Panico", Tricase, Italy
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alessia Giugno
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G.Panico", Tricase, Italy
| | - Chiara Zecca
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G.Panico", Tricase, Italy
| | - Davide Vilella
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G.Panico", Tricase, Italy
| | - Maria Accadia
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G.Panico", Tricase, Italy
| | - Roberta Barone
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G.Panico", Tricase, Italy
| | - Maria Teresa Dell'Abate
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G.Panico", Tricase, Italy
| | - Roberto De Blasi
- Department of Diagnostic Imaging, Pia Fondazione di Culto e Religione "Card. G.Panico", Tricase, Italy
| | - Paolo Manganotti
- Department of Medicine, Surgery and Health Sciences, Clinical Unit of Neurology, University Hospital of Trieste, University of Trieste, Trieste, Italy
| | - Giancarlo Logroscino
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G.Panico", Tricase, Italy
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Fanti E, Di Sarno M, Di Pierro R. In search of hidden threats: A scoping review on paranoid presentations in personality disorders. Clin Psychol Psychother 2023; 30:1215-1233. [PMID: 37727949 DOI: 10.1002/cpp.2913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/25/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
Recent diagnostic developments suggest that paranoia is a transdiagnostic characteristic common to several personality disorders rather than a personality disorder per se. Nonetheless, empirical literature fails to provide comprehensive and univocal findings on whether and how paranoid presentations relate to different personality disorders. In the present scoping review, we map the empirical literature on paranoid presentations in personality disorders, considering the entire spectrum of paranoid manifestations (i.e., the paranoia hierarchy). In selecting original quantitative studies on paranoid presentations in personality-disordered patients, we screened 4,433 records in PsycArticles, PsycInfo and PUBMED. We eventually included 47 eligible studies in the review. Our synthesis indicates consistent empirical evidence of a wide range of paranoid presentations in Paranoid, Schizotypal and Borderline personality disorders. Conversely, little empirical literature exists on paranoid presentations in other personality disorders. Preliminary findings suggest broad-severity paranoid presentations, ranging from milder to severe forms, in Paranoid, Schizotypal and Borderline personality disorders. There is also some evidence of milder forms of paranoia in Avoidant, Antisocial and Narcissistic personality disorders. Conversely, there is poor evidence of paranoid presentations in Schizoid, Histrionic, Dependent or Obsessive-compulsive personality disorders. Research gaps and recommendations for improving empirical research on paranoid presentations in personality disorders are discussed.
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Affiliation(s)
- Erika Fanti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Marco Di Sarno
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Personality Disorder Lab (PDLab), Milan-Parma, Italy
| | - Rossella Di Pierro
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Personality Disorder Lab (PDLab), Milan-Parma, Italy
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