Narcissistic personality disorder.

ABSTRACT Clinical theorists across various orientations describe individuals diagnosed with narcissistic personality disorder as those characterized by a pervasive pattern of grandiosity, a sense of privilege or entitlement, an expectation of preferential treatment, an exaggerated sense of self-importance, and arrogant or haughty behaviors or attitudes (Westen & Shedler, 1999). Despite common clinical usage, the concept of narcissistic personality disorder is highly controversial and of uncertain validity. The vast majority of the literature on narcissistic personality disorder has been theoretical and clinical rather than empirical. The research that does exist, with a few important exceptions, has not been carried out programmatically. In this chapter, we will summarize and integrate the best available scientific evidence bearing on the etiology, assessment, diagnosis, course, and treatment of the disorder. We will begin with a brief history of the concept of narcissistic personality disorder, then review and evaluate a number of conceptualizations, and conclude with recommendations for further research on unresolved conceptual and methodological issues as we look toward DSM-V. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

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    ABSTRACT: The impact of pathological narcissism on psychotherapy has seldom been investigated empirically, despite extensive clinical theory proposing that highly narcissistic individuals should be reluctant to engage in treatment and derive smaller benefits from therapy. In this study, we investigate the relationship between scores on the Pathological Narcissism Inventory (PNI; Pincus et al., 2009 ), which assesses both narcissistic grandiosity and narcissistic vulnerability, and clinical variables in a sample of outpatients (N = 60) at a community mental health center. Results indicated that grandiosity, but not vulnerability, was negatively related to the use of adjunctive services and positively predicted client-initiated termination of psychotherapy. In addition, grandiosity and vulnerability were related to initial levels of different symptoms in multilevel models using a subsample (n = 41) but not generally related to the linear rate of symptom change in early psychotherapy. The results highlight the clinical utility of assessing pathological narcissism in a real-world psychotherapeutic context.
    Journal of Personality Assessment 11/2012; 95(3). DOI:10.1080/00223891.2012.742904 · 2.01 Impact Factor
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    ABSTRACT: This article presents a therapeutic approach for patients with severe personality disorders, transference-focused psychotherapy (TFP), a manualized evidence-based treatment, which integrates contemporary object relations theory with attachment theory and research. Case material is presented from a narcissistic personality disorder (NPD) patient in TFP whose primary presenting problems were in the arena of sexuality and love relations, and whose attachment state of mind showed evidence of oscillation between dismissing and preoccupied mechanisms. Clinical process material is presented to illustrate the tactics and techniques of TFP and how they have been refined for treatment of individuals with NPD. The ways in which conflicts around sexuality and love relations were lived out in the transference is delineated with a focus on the interpretation of devalued and idealized representations of self and others, both of which are key components of the compensatory grandiose self that defensively protects the individual from an underlying sense of vulnerability and imperfection.
    Journal of Clinical Psychology 11/2013; 69(11). DOI:10.1002/jclp.22042 · 2.12 Impact Factor
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    Psychoanalytic Inquiry 11/2013; 33(6):527-551. DOI:10.1080/07351690.2013.815087 · 0.47 Impact Factor