Metacognitive Interpersonal Therapy for Narcissistic Personality Disorder and Associated Perfectionism

Center for Metacognitive Interpersonal Therapy, Rome, Italy.
Journal of Clinical Psychology (Impact Factor: 2.12). 08/2012; 68(8):922-34. DOI: 10.1002/jclp.21896
Source: PubMed


Treating narcissistic personality disorder (NPD) successfully is possible but requires a thorough understanding of the pathology and appropriate clinical procedures. Perfectionism is one prominent feature often associated with narcissistic difficulties. Metacognitive Interpersonal Therapy (MIT) for NPD adopts manualized step-by-step procedures aimed at progressively dismantling narcissistic processes by first stimulating an autobiographical mode of thinking and then improving access to inner states and awareness of dysfunctional patterns. Finally, adaptive patterns of thinking, feeling, and acting are promoted, together with a sense of autonomy and agency and a reduction of perfectionistic regulatory strategies. Throughout, there needs to be constant attention to regulation of the therapy relationship to avoid ruptures and maximize cooperation. We describe here a successful case of MIT applied to a man in his early 20's with narcissism, perfectionism, and significant co-occurrence of Axis I and Axis II disorders.

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    • "Using a 28-day daily diary design, we also sought to test a mediation model wherein narcissistic perfectionism and self-critical perfectionism predict conflict with others and derogation of others, but through different pathways. According to theory, narcissistic perfectionists derogate others and experience conflict with others because people do not live up to their grand expectations (Dimaggio & Attinà, 2012; Ellis, 1997). In contrast, research suggests self-critical perfectionists derogate others and experience conflict with others because they believe others expect too much of them (Mushquash & Sherry, 2012). "
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    ABSTRACT: Narcissistic perfectionism is frequently described in theory, but there are no empirically tested models of this construct. Our study tested a model of narcissistic perfectionism, and differentiated this construct from self-critical perfectionism. Data from two samples of undergraduates, including a 28-day daily diary study, were used to test the factorial validity of narcissistic perfectionism and its unique indirect pathways to aversive social behavior. Results supported the factorial validity of narcissistic perfectionism as distinct from self-critical perfectionism, and each perfectionism construct predicted negative social behaviors through overlapping but distinct forms of perfectionistic discrepancies. Our study suggests narcissistic perfectionism is a distinct personality construct that predicts aversive social behavior, thereby supporting theoretical descriptions of this oft-discussed, but rarely studied, personality construct.
    Journal of Research in Personality 03/2015; 57. DOI:10.1016/j.jrp.2015.02.006 · 2.00 Impact Factor
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    • "In addition, more focused psychotherapeutic efforts should aim to disclose and address perfectionistic cognitions in narcissistic individuals, as it can lead to negative subjective states and even possible suicide risk. Finally, perfectionism is also relevant to the efficacy of psychotherapy, where it can often impede the disclosure of a patient's imperfections, the formation of a positive therapeutic alliance, and treatment progress in general (Dimaggio & Attina, 2012; Ronningstam, 2011, 2012). "
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    ABSTRACT: The aim of this study was to examine the relationships between pathological narcissism (narcissistic grandiosity and narcissistic vulnerability), dysfunctional attitudes (perfectionism and dependency on other people), and depressive symptoms in psychiatric outpatients. A sample of 234 adult psychiatric outpatients (57.3% male; mean age 44.39 years) completed the Pathological Narcissism Inventory, the Dysfunctional Attitudes Scale-Form A, and the Depression, Anxiety, Stress Scales-21. Narcissistic vulnerability exhibited unique positive correlations with depressive symptoms, whereas narcissistic grandiosity showed substantially weaker correlations with depressive symptoms. Perfectionism partially mediated the relationship between narcissistic vulnerability and depressive symptoms. The mediating role of dependency was not confirmed. Among adult psychiatric outpatients, narcissistic vulnerability is more strongly related to depressive symptoms than narcissistic grandiosity, and dysfunctional perfectionism represents one of the underlying mechanisms of this relationship. The implications of these findings are discussed in relation to the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria and the treatment of pathological narcissism.
    Journal of Clinical Psychology 04/2014; 70(4). DOI:10.1002/jclp.22033 · 2.12 Impact Factor
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    • "Interestingly, some therapeutic approaches for personality disorders and schizophrenia (e.g., Lysaker et al., 2007, 2011; Dimaggio and Attinà, 2012; Dimaggio et al., 2012) insist on the importance of eliciting patients’ specific memories of relevant social interactions (as opposed to resorting to overgeneralized memories), to help patients appreciate psychological causalities, and track down the mental states of the individuals involved more accurately. For example, Dimaggio and Attinà (2012) described a patient with a narcissistic personality disorder who arrived demoralized at one session reporting that he had been socially rejected by two peers at a party. By re-exploring the original event with the therapist, he was able to recall additional contextual details (“There were more of us, and we were more familiar with each other. "
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    ABSTRACT: Functional neuroimaging studies have noted that brain regions supporting theory of mind (ToM) overlap remarkably with those underlying episodic memory, suggesting a link between the two processes. The present study shows that memory for others' past experiences modulates significantly our appraisal of, and reaction to, what is happening to them currently. Participants read the life story of two characters; one had experienced a long series of love-related failures, the other a long series of work-related failures. In a later faux pas recognition task, participants reported more empathy for the character unlucky in love in love-related faux pas scenarios, and for the character unlucky at work in work-related faux pas scenarios. The memory-based modulation of empathy correlated with the number of details remembered from the characters' life story. These results suggest that individuals use memory for other people's past experiences to simulate how they feel in similar situations they are currently facing. The integration of ToM and memory processes allows adjusting mental state inferences to fit unique social targets, constructing an individualized ToM.
    Frontiers in Psychology 02/2013; 4:4. DOI:10.3389/fpsyg.2013.00004 · 2.80 Impact Factor
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