Nicole Cain

• PhD
• Associate Professor at Rutgers, The State University of New Jersey

The Psychodynamic Diagnostic Manual (PDM; PDM Task Force, 2006) and its subsequent second edition (PDM-2; Lingiardi & McWilliams, 2017) aims to provide a “taxonomy of people” rather than a “taxonomy of disorders.” The Psychodiagnostic Chart (PDC; Gordon & Bornstein, 2012) and PDC-2 (Gordon & Bornstein, 2015) is a clinician-rated instrument designed...

Kernberg’s (1984) conceptualization of malignant narcissism describes individuals whose pathological grandiosity has been infiltrated by high levels of aggression and includes associated clinical characteristics such as paranoia, psychopathy, and sadism. While a theoretically rich construct, there has been limited empirical assessment of malignant...

Transference-focused psychotherapy (TFP) is an empirically supported treatment for borderline personality disorder (BPD) that improves functioning via targeting representations of self affectively relating to others, particularly as evoked in the therapeutic relationship. If change in TFP operates as theorized, then shifts in patterns of “self affe...

The QAnon conspiracy theory gained popularity on internet forums and social media sites between 2017 and 2021. The theory posits that there is a cabal of Satan-worshiping elites who engage in child sex trafficking for the purposes of harvesting adrenochrome, and it is believed many Hollywood elites and politicians take part in these rituals. Althou...

Indirect assessment is a useful tool in forensic evaluation, especially in cases of threat assessment. To this end, we illustrated the ability to conceptualize a complicated case (i.e., Theodore John Kaczynski) using an indirect approach, with a particular emphasis upon dimensional frameworks of personality. Raters who were unrelated to Mr. Kaczyns...

Previous research has shown that narcissism is associated with interpersonal difficulties and maladaptive affective responses to social rejection. In the current studies, the authors examined two phenotypes of pathological narcissism, narcissistic grandiosity and narcissistic vulnerability, and their impact on individuals' affective responses in tw...

This chapter reviews the Contemporary Integrative Interpersonal Theory (CIIT) of personality as it relates to personality dynamics unfolding over time. The interpersonal tradition is rich with theory and research supporting a context-driven and temporally dynamic interplay of the self and important others. The dimensions of agency and communion are...

Introduction Effortful control (EC) is the self‐regulatory aspect of temperament that is thought to reflect the efficiency of executive attention (EA). Findings on relationship between EC and performance on EA tasks among adults are still contradictory. This study used a computational approach to clarify whether greater self‐reported EC reflects be...

Obsessive‐Compulsive Personality Disorder (OCPD) is a mental disorder that is characterized by a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control. The symptoms associated with OCPD often occur at the expense of flexibility, openness, and efficiency, thus leading to significant impairment in wo...

Obsessive‐Compulsive Personality Disorder (OCPD) is a mental disorder that is characterized by a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control. The symptoms associated with OCPD often occur at the expense of flexibility, openness, and efficiency, thus leading to significant impairment in wo...

Previous research has shown that narcissism is associated with interpersonal difficulties and maladaptive affective responses to social rejection. In the current studies, the authors examined two phenotypes of pathological narcissism, narcissistic grandiosity and narcissistic vulnerability, and their impact on individuals' affective responses in tw...

Criteria A of the DSM-5 Alternative Model for Personality Disorders (AMPD) defines personality pathology in terms of impairments in "self" (identity, self-direction) and "interpersonal" (empathy, intimacy) functioning. Articulated as a set of dynamic regulatory and relational processes that are stratified in the Level of Personality Functioning Sca...

Background: Emotion dysregulation and the internalization of sociocultural body image norms have been individually associated with eating pathology, but most studies utilized samples that were female, not ethnically diverse, or experiencing only diagnosable levels of eating pathology. Purpose: This study sought to better explain the relationship be...

Background: Conceptualizations of personality disorders (PD) are increasingly moving towards dimensional approaches. The definition and assessment of borderline personality disorder (BPD) in regard to changes in nosology are of great importance to theory and practice as well as consumers. We studied empirical connections between the traditional DSM...

The present research case sought to illustrate how self-regulatory patterns of interpersonal behavior manifest within a rejection sensitive individual at the daily level. Cross-sectional research has demonstrated negative relational outcomes associated with rejection sensitivity, but less attention has been paid to how this manifests in daily relat...

Doctoral dissertation submitted to the graduate faculty of the Richard L. Conolly College of Long Island University in partial fulfillment of the requirements for the degree of Doctor of Philosophy.

Research has shown differences in the characteristics of suicidal behavior in individuals with dependent (anaclitic) versus self-critical (introjective) personality styles. Questions remain, however, as to what factors distinguish suicidal from nonsuicidal individuals within each personality style. The current study examined clinical and interperso...

Refined and revised MMPO-2 Personality Disorder scales

We describe updated and revised MMPI-2 scales for personality disorder (PD) using Loevinger’s (1957) integrated construct validation (CV) approach to guide scale development. Dimensionalized PD “Spectra” scales were constructed out of the item pool of all previous MMPI-2 PD scales using content validity, item-analytic, and external criterion compar...

The DSM-5 Section III alternative model for personality disorders (AMPD) is a personality disorder (PD) nosology based on severity of personality dysfunction and pathological traits. We examined the degree to which the personality constructs identified by McAdams and Pals (2006; dispositional traits, characteristic adaptations, narrative identity)...

The role of effortful control in performing an executive attention task: a new computational approach Background: A major challenge in psychopathology research is understanding how psychiatric disturbances relate to underlying normal and abnormal mental processes. In this regard, an important dimension of cognitive and behavioural functioning is E...

Background: Normal and pathological narcissism have been the focus of considerable theoretical discussion and empirical research in recent years in personality psychology and psychopathology. Kernberg [ 1 - 4 ] has argued that there is a particularly dysfunctional and impairing variant of narcissistic disturbance known as malignant narcissism. Thi...

The DSM–5 Section III alternative model for personality disorders (AMPD) is a personality disorder (PD) nosology based on severity of personality dysfunction and pathological traits. We examined the degree to which the personality constructs identified by McAdams and Pals (2006; dispositional traits, characteristic adaptations, narrative identity)...

The DSM–5 Section III alternative model for personality disorders (AMPD) is a personality disorder (PD) nosology based on severity of personality dysfunction and pathological traits. We examined the degree to which the personality constructs identified by McAdams and Pals (2006; dispositional traits, characteristic adaptations, narrative identity)...

Narcissistic personality disorder (NPD) is associated with both seeming indifference and hypersensitivity to social feedback. This study evaluated whether rejection sensitivity and empathic difficulties in NPD are accounted for by altered facial emotion recognition (FER). Two-hundred non-clinical individuals self-reported NPD features, rejection se...

Rejection sensitivity (RS) was evaluated as a moderator of the relationship between perceptions of others and interpersonal behavior over the course of a week. Participants (n = 240) were non-clinical young adults who completed a 7-day event-contingent experience sampling study of interpersonal perception and affect. Multilevel linear models indica...

The Cognitive-Affective Processing System (CAPS) was used to examine effortful control (EC) as a moderator of daily interpersonal behavior. Participants (N = 240) were nonclinical young adults who completed a 7-day event-contingent experience sampling study of interpersonal perception and affect. Multilevel linear models indicated that EC moderated...

There are many ways to configure Borderline Personality Disorder (BPD) diagnosis: by categories of polythetic criteria (e.g., per DSM-III to-5-II), dimensional models (e.g., DSM-V-III; Simms' CT-25, Livelsley's DAAP-BQ, FFM versions, etc.), & theoretically-based models (e.g., Kernberg's psychostructural scheme). Criterion B of the DSM-5-III Alterna...

The exploration of countertransference has been a topic typically reserved for the psychoanalytic and psychodynamic literature. However, regardless of theoretical orientation, correctional therapy clients often elicit strong reactions in their mental health practitioners, due to the level of psychopathology typically seen in this population, the cr...

Despite robust findings identifying impairments in interpersonal functioning associated with rejection sensitivity (RS), the object representations (OR) of self in relation to others from which such rejection expectancies and anxieties arise have not been evaluated. Our study was the first effort to evaluate the structural aspects of object represe...

The most current conceptualization of personality pathology emphasizes the assessment of the severity of selected domains of functioning involving lack of accurate perceptions of self and others that are common across the personality disorder categories. Advances in our understanding of personality pathology have stimulated further development of T...

This study examines psychopathology and clinical characteristics of patients with borderline personality disorder (BPD) and comorbid narcissistic personality disorder (NPD) from two international randomized controlled trials. From a combined sample of 188 patients with BPD, 25 also fulfilled criteria for a comorbid diagnosis of NPD according to DSM...

In recent years, prisons and jails have become de facto psychiatric hospitals, responsible for the care and treatment of individuals with serious mental illness. Historically, cognitive-behaviorally informed therapeutic approaches have been the treatment of choice among mental health practitioners in correctional settings. However, inmate-clients o...

Background: Partnerships between mental health care stakeholders provide a context for generalizable clinical research with implications for quality improvement. In the context of a partnership between an adolescent residential substance abuse disorder (SUD) treatment center and clinical researchers, stakeholders identified knowledge gaps (internal...

Individuals high in rejection sensitivity (RS) are at risk for experiencing high levels of interpersonal distress, yet little is known about the interpersonal profiles associated with RS. This investigation examined the interpersonal problems, sensitivities, and values associated with RS in 2 samples: 763 multicultural undergraduate students (Study...

This investigation examined the moderating role of effortful control (EC) in the association between rejection sensitivity (RS) and its subsequent interpersonal distress (IP-distress) on borderline personality disorder (BPD) features. In total, 625 multicultural undergraduates (Study 1) and 562 community international adults (Study 2) completed sca...

Research evaluating mental state identification in individuals with borderline pathology has yielded inconsistent results; contradictory findings were hypothesized to be driven by moderating effects of childhood trauma. Participants were 105 ethnically diverse men and women who exhibited a range of borderline pathology measured by Diagnostic and St...

AimBorderline personality disorder (BPD) is characterized by self-regulation deficits, including impulsivity and affective lability. Transference-Focused Psychotherapy (TFP) is an evidence-based treatment proven to reduce symptoms across multiple cognitive-emotional domains in BPD. This pilot study aims to investigate neural activation associated w...

The context-free diagnoses outlined by the Diagnostic and Statistical Manual of Mental Disorders might not provide enough information to represent the heterogeneity observed in depressed patients. Interpersonal factors have been linked to depression in a mutually influencing pathoplastic relationship where certain problems, like submissiveness, are...

Suicide is estimated to be 1 of the top 5 leading causes of death for individuals between the ages of 5 and 44. Although the majority of empirical research on suicide has focused on specific risk factors, this has not led to improvement in the prediction of suicide in specific individuals. Contemporary theories such as the Interpersonal-Psychologic...

We describe a framework for the application of treatment modules to the major domains of dysfunction manifested by clients with personality disorder. This integrated approach takes the clinician beyond the existing limited treatment research by using strategies and techniques from all the major treatment schools and orientations. This effort is nec...

While studies have demonstrated connections between impairments in object relations and self-destructive behaviors in individuals with borderline personality disorder (BPD), few have investigated whether these impairments relate to actual suicidal behaviors. The current study utilized the Social Cognition and Object Relations Scale-Global Method to...

The Multidimensional Personality Questionnaire (MPQ) is a self-report instrument that assesses personality, and it was developed by Auke Tellegen (b. 1930) and colleagues over a period of 10 years using an exploratory approach to test construction. It consists of 276 mostly true-false items measuring a range of dispositions via 11 primary trait sca...

We investigated attachment representations and the capacity for mentalization in a sample of adult female borderline patients with and without comorbid narcissistic personality disorder (NPD). Participants were 22 borderline patients diagnosed with comorbid NPD (NPD/BPD) and 129 BPD patients without NPD (BPD) from 2 randomized clinical trials. Atta...

The core symptoms of obsessive-compulsive personality disorder (OCPD) often lead to interpersonal difficulties. However, little research has explored interpersonal functioning in OCPD. This study examined interpersonal problems, interpersonal sensitivities, empathy, and systemizing, the drive to analyze and derive underlying rules for systems, in a...

Research has consistently found high rates of comorbidity between narcissistic personality disorder (NPD) and borderline personality disorder (BPD). Patients with this complex clinical presentation often present formidable challenges for clinicians, such as intense devaluation, entitlement, and exploitation. However, there is a significant gap in t...

The study examined whether successively presented subliminal and supraliminal morality salience primes ("double death" prime) would have a stronger influence on death thought accessibility than subliminal or supraliminal primes alone. A between subjects 2 (subliminal prime/ control) x 2 (supraliminal prime/ control) design was used. The supralimina...

This article briefly summarizes the empirical and clinical literature underlying a contemporary clinical model of pathological narcissism. Unlike the DSM Narcissistic Personality Disorder (NPD), this clinical model identifies and differentiates between two phenotypic themes of dysfunction-narcissistic grandiosity and narcissistic vulnerability-that...

The present study evaluates the relationship between effortful control (EC) and externalizing psychopathology in young adults. EC, the capacity to delay immediate impulses in favor of long-term goals, has been robustly linked to externalizing behaviors in children and adolescents. However, such data is limited in adults, and mechanisms underlying t...

Research has linked individual differences in effortful control (EC) with variations in interpersonal functioning in children and adolescents. Using the Inventory of Interpersonal Problems-Short Circumplex (Hopwood, Pincus, DeMoor, & Koonce, 2008), this study investigated interpersonal problem profiles associated with EC in 763 nonclinical young ad...

Individuals with OCD or hoarding symptoms frequently report experiencing traumas and traumatic events may be a risk factor for anxiety and mood disorders; however, little research has compared rates of specific traumas in those with OCD symptoms alone, hoarding symptoms alone, or comorbid OCD and hoarding symptoms. Participants were individuals wit...

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 Narci...

The identification of reliable predictors of course in major depressive disorder (MDD) has been difficult. Evidence suggests that the co-occurrence of personality pathology is associated with longer time to MDD remission. Interpersonal pathoplasticity, the mutually influencing nonetiological relationship between psychopathology and interpersonal tr...

Interpersonal assessment may provide a clinically useful way to identify subtypes of social phobia. In this study, we examined evidence for interpersonal subtypes in a sample of 77 socially phobic outpatients. A cluster analysis based on the dimensions of dominance and love on the Inventory of Interpersonal Problems-Circumplex Scales (Alden, Wiggin...

The construct of narcissism is inconsistently defined across clinical theory, social-personality psychology, and psychiatric diagnosis. Two problems were identified that impede integration of research and clinical findings regarding narcissistic personality pathology: (a) ambiguity regarding the assessment of pathological narcissism vs. normal narc...

This review documents two themes of emphasis found in phenotypic descriptions of pathological narcissism across clinical theory, social/personality psychology, and psychiatric diagnosis. Clinical theories of narcissism spanning 35 years consistently describe variations in the expression of pathological narcissism that emphasize either grandiosity o...