The Impact of Narcissism on Drop-out From Cognitive-Behavioral Therapy for the Eating Disorders

Sub-department of Clinical Health Psychology, University College London, United Kingdom.
The Journal of nervous and mental disease (Impact Factor: 1.69). 05/2009; 197(4):278-81. DOI: 10.1097/NMD.0b013e31819dc150
Source: PubMed


This study examined the relationship between narcissism and drop-out from the early stage of cognitive behavioral therapy (CBT) for the eating disorders. Narcissism was defined in terms of both its core elements and the narcissistic defense styles. The participants were 41 patients presenting for CBT at a specialist eating disorders service. Each completed measures of narcissism and eating disorder psychopathology. Attendance at sessions was also recorded. The presence of the narcissistically abused personality defense style was associated with a higher likelihood of dropping out of outpatient CBT. This "martyred" form of narcissism appears to have a significant role in the adherence to treatment for the eating disorders. The limitations and the clinical implications of this preliminary research are discussed, and future directions for research are suggested.

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    • "Some subscales of the Minnesota Multiphasic Personality Inventory were linked to dropout in a sample of 75 Japanese anorectic inpatients (Nozaki et al., 2007). One study (Campbell et al., 2009) studied the impact of narcissism (defence style, pathological narcissism) on dropout from cognitive-behavioral therapy for eating disorders, but in an outpatient setting. Three studies (Dalle Grave et al., 2008; Fassino et al., 2002, 2003) used the Temperament and Character Inventory (TCI, Cloninger et al., 1993) to assess the influence of personality dimensions on dropout from treatment for eating disorders. "
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    ABSTRACT: Dropout rates from inpatient treatment for eating disorders are very high and have a negative impact on outcome. The purpose of this study was to identify personality factors predictive of dropout from hospitalization. A total of 64 adult patients with anorexia nervosa consecutively hospitalized in a specialized unit were included; 19 patients dropped out. The dropout group and the completer group were compared for demographic variables, clinical features, personality dimensions, and personality disorders. There was no link between clinical features and dropout, and among demographic variables, only age was associated with dropout. Personality factors, comorbidity with a personality disorder and Self-transcendence dimension, were statistically predictive of premature termination of hospitalization. In a multivariate model, these two factors remain significant. Personality traits (Temperament and Character Inventory personality dimension and comorbid personality disorder) are significantly associated with dropout from inpatient treatment for anorexia nervosa. Implications for clinical practice, to diminish the dropout rate, will be discussed.
    The Journal of nervous and mental disease 08/2012; 200(9):807-13. DOI:10.1097/NMD.0b013e318266bbba · 1.69 Impact Factor
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    • "Factors affecting this phenomenon have already been studied. A significant association has been found with the purging type anorexia nervosa (AN-P), psychiatric comorbidity and impulse control problems, but non-compliance and premature therapy interruption are affected primarily by factors that are related to patient's attitude and behaviour (Bandini et al., 2006; Campbell, Waller, & Pistrang, 2009; de Graaf, Bijl, Smit, Ravelli, & Vollebergh, 2000). The most common reasons stated are low motivation and/or dissatisfaction with the treatment or the therapist (46.7%), external difficulties (40%) and patients' feeling of improvement (13.3%) (Bados, Balaguer, & Saldana, 2007). "
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    ABSTRACT: This study examined dropout-related factors at the Outpatient Eating Disorders Treatment Programme. One hundred ninety-six eating disorders patients following DSM-IV diagnostic criteria that consecutively commenced treatment were recruited and followed up for a 2-year period. A total of 151 patients completed the whole assessment with a set of questionnaires evaluating eating and general psychopathology. The Attitudes towards Change in Eating Disorders questionnaire was used, and personality was evaluated using the Temperament and Character Inventory. During the follow-up period, patients were re-assessed. Two years later, 102 patients continued on treatment. Scores on Precontemplation at the beginning were predictors for dropout at 2-year follow-up. Character variables, as Responsibility, Integrity and Self-acceptance were protective factors to be at Precontemplation stage. The clinician's challenge is to help eating disorders patients to develop an unyielding sense of responsibility and self-acceptance, aimed to integrate the therapeutic choice into their own intrapersonal frame of goals.
    European Eating Disorders Review 05/2012; 20(3):e123-8. DOI:10.1002/erv.2157 · 2.46 Impact Factor
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    ABSTRACT: Objective There is evidence that core narcissism and the narcissistic defenses have a role in the emotions and cognitions associated with the eating disorders. However, there is little understanding of its relationship with behaviors seen in this population. This study aimed to examine the relationship between narcissism and eating-disordered behaviors (e.g., bingeing and purging).Method The participants, 110 women presenting with an eating disorder, completed measures of narcissism and eating disorder psychopathology.ResultsAssociations were found between patients who engaged in excessive exercise and levels of narcissism. There were also dimensional associations between eating-disordered behaviors and specific aspects of narcissism.DiscussionClinical implications and limitations of the study are discussed, and future directions for research suggested. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010; 43:560–564
    International Journal of Eating Disorders 09/2010; 43(6):560 - 564. DOI:10.1002/eat.20739 · 3.13 Impact Factor
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