Narcissistic Vulnerability and the Development of PTSD

Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem, Israel.
Journal of Nervous & Mental Disease (Impact Factor: 1.69). 12/2005; 193(11):762-5. DOI: 10.1097/01.nmd.0000185874.31672.a5
Source: PubMed


This study empirically examined the role of narcissistic traits and narcissistic vulnerability in the development of post-traumatic stress disorder (PTSD). One hundred forty-four survivors of a traumatic event were assessed 1 week, 1 month, and 4 months following the event. In the first-week assessment, patients were administered the Narcissistic Vulnerability Scale and self-reported rating scale to assess event severity and symptoms ensuing from the impact of the traumatic event: depression, intrusions, avoidance, and arousal. In the follow-up assessments, subjects were interviewed on the Clinician-Administered PTSD Scale and were readministered the self-rating symptoms scale. Survivors who developed acute (1 month) and chronic (4 months) PTSD had significantly higher levels of narcissistic vulnerability in the first-week assessment. Narcissistic Vulnerability Scale scores predicted PTSD status with sensitivity of 81.6% and 85.1% and specificity of 40.4% and 38.6% at the 1-month and 4-month assessments, respectively. Narcissistic vulnerabilities contribute to the occurrence of PTSD.

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    • "For example, schizotypal, an‐ tisocial, borderline, histrionic and dependent personality traits present in adolescence and early adulthood have been associated with higher risk of having an anxiety disorder by mid‐ dle adulthood [21]. In one study [22], high narcissistic personality traits, measured one week after trauma, have been associated with an increased risk of developing posttraumatic stress disorder (PTSD) one month and four months after trauma, even when controlling for baseline anxiety disorders. However, Brandes and Bienvenu [23] mentioned that these findings do not consider possible causal mechanisms involved. "
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    ABSTRACT: The prevalence of personality disorders varies between 0.5% and 2.5% in the general population and it increases drastically in the clinical population [1, 2]. In a psychiatric population, about one half of all patients have pathological personality [3]. Following the multiaxial classification of the Diagnostic Manual of the American Psychiatric Association (DSM-IVTR; [1]), Axis II personality disorders are defined as being stable, inflexible, and pervasive patterns of psychological experiences and behaviors that differ prominently from cultural expectations, and that lead to clinically significant distress or impairment in important areas of functioning. In the DSM-IV-TR, there are 10 distinct personality disorders organized into three clusters. Cluster ″A″ includes three personality disorders considered as odd or eccentric: paranoid, schizoid and schizotypal. Antisocial, borderline, narcissistic and histrionic personality disorders are grouped under Cluster ″B″, which is considered as the dramatic, emotional or erratic cluster. Finally, Cluster ″C″ comprises three anxious or fearful personality disorders: the avoidant personality disorder, the dependent personality disorder and the obsessive-compulsive personality disorder. In the next version of the DSM (DSM-V), the task force is proposing some major changes for Axis II and as per the may 1st 2012 online revision[4], the DSM-V will retain six personality disorder types : schizotypal, antisocial, borderline, narcissistic, avoidant and obsessive-compulsive. The comorbidity between Axis I and Axis II disorders is much documented, and there are some voices in the scientific community that would even question whether or not the distinction between those two axis should be revisited [5-8]. Specifically, Axis II disorders have been found to be strongly associated with anxiety disorders [9, 10] and an increased prevalence of personality disorders has been found in patients with anxiety disorders [11, 12]. Personality disorders are associated to high social cost and mortality, such as crime, disability, underachievement, underemployment, increased need for medical care, institutionalization, suicide attempts, self-injurious behavior, family disruption, child abuse and neglect, poverty, and homelessness [12]. This underlies the importance of finding optimal treatment for this population, and understanding the mechanisms by which personality pathology interferes with other psychiatric disorders, such as anxiety disorders. This chapter presents a comprehensive review of the literature on the co-occurrence of personality and anxiety disorders, and the treatment of the latter when comorbidity occurs. First, the influence of personality pathology on anxiety disorders in general is discussed, with no regard to specific anxiety disorders. Afterwards, the clinical features of each of the major anxiety disorders that are comorbid with personality disorders are examined separately. The influence of personality disorders on anxiety disorder symptomatology and on the course of illness is also discussed in terms of treatment. Emphasis will be on the outcome of cognitive and/or behavioral therapy, since its efficacy has been repeatedly established in the treatment of anxiety disorders. The influence of Axis II diagnosis on the outcome of pharmacological treatment of anxiety disorders is also briefly discussed. Major characteristics of the studies that are reviewed in the present chapter are presented in a table. Finally, future research questions on comorbidity of anxiety disorders in the presence of personality disorders are proposed.
    New Insights into Anxiety Disorders, 01/2013: chapter 12: pages 287-324; , ISBN: ISBN 978-953-51-1053-8
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    • "First, pre-trauma personality characteristics may increase the likelihood of trauma exposure and/or predispose an individual to develop PTSD (Axelrod et al., 2005; Bachar et al., 2005; Bramsen et al., 2000; Gunderson et al., 1993; Marzillier & Steel, 2007). For example, pretrauma borderline (Axelrod et al., 2005), neurotic (Bramsen et al., 2000), narcissistic (Bachar et al., 2005), and schizotypal (Berenbaum et al., 2008; Berenbaum et al., 2003; Marzillier & Steel, 2007) personality characteristics have been identified as vulnerability factors for PTSD. Second, severe trauma may itself cause enduring symptoms that are associated with PDs. "
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    ABSTRACT: While it is well known that personality disorders are associated with trauma exposure and PTSD, limited nationally representative data are available on DSM-IV personality disorders that co-occur with posttraumatic stress disorder (PTSD) and partial PTSD. Face-to-face interviews were conducted with 34,653 adults participating in the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Logistic regression analyses controlling for sociodemographics and additional psychiatric comorbidity evaluated associations of PTSD and partial PTSD with personality disorders. Prevalence rates of lifetime PTSD and partial PTSD were 6.4% and 6.6%, respectively. After adjustment for sociodemographic characteristics and additional psychiatric comorbidity, respondents with full PTSD were more likely than trauma controls to meet criteria for schizotypal, narcissistic, and borderline personality disorders (ORs = 2.1-2.5); and respondents with partial PTSD were more likely than trauma controls to meet diagnostic criteria for borderline (OR = 2.0), schizotypal (OR = 1.8), and narcissistic (OR = 1.6) PDs. Women with PTSD were more likely than controls to have obsessive-compulsive PD. Women with partial PTSD were more likely than controls to have antisocial PD; and men with partial PTSD were less likely than women with partial PTSD to have avoidant PD. PTSD and partial PTSD are associated with borderline, schizotypal, and narcissistic personality disorders. Modestly higher rates of obsessive-compulsive PD were observed among women with full PTSD, and of antisocial PD among women with partial PTSD.
    Journal of Psychiatric Research 10/2010; 45(5):678-86. DOI:10.1016/j.jpsychires.2010.09.013 · 3.96 Impact Factor
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