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Bridging the evidence-based gap: From pathological narcissism to narcissism survivors
Abstract
Psychological evidence-based research on narcissism has traditionally been divided into two main streams: Social-personality psychology focusing on Trait Narcissism (Campbell & Foster, 2007; Morf & Rhodewalt, 2010) and clinical psychology and psychiatry studying psychopathology of Narcissistic Personality Disorder (NPD) (American Psychiatric Association, 2013). As a result, theory-rich clinical frameworks have been separated from data-rich empirical approaches in social-personality psychology, leading to inevitable conceptual confusion (Campbell & Miller, 2011). Clinically oriented theorists have been emphasizing narcissistic vulnerability whilst social-personality researchers have centred around narcissistic grandiosity which ironically have become the focus of NPD diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013). Whilst significant attempts were made to marry diverse groups of narcissism researchers and clinicians, startling gaps in evidence-based research on narcissism and familial concepts keep being brought into light to this day (Day, Bourke, Townsend, & Grenyer, 2019a; Miller et al., 2017). That is, conceptual dealings around narcissism in evidence based psychology seemed to have left devastating experiences of Narcissism Survivors unattended, which, not surprisingly, have been well captured world widely by advocacy and self-help community (Hintjens, 2015; Manne, 2015; Manson, 2019; Narcissist Abuse Support, 2019; Patients Like Me, 2019; Reddit, 2013; World Narcissistic Abuse Awareness Day (WNAAD), 2019). This article provides a brief history of the concept of narcissism and outlines the evidence-based research gap pertaining to narcissism survivors as well as most current and future research endeavours. The article concludes with a case study which offers a graphic example of pathological narcissism and its impact on narcissism targets in the context of romantic relationships.
Helping professions necessitate a certain extent of emotional intelligence and creativity which have previously been linked with narcissism. Our study aims to illustrate a comparison between medical practitioners and educators aged between 28-65 years, with respect to creativity, emotional intelligence and narcissism. The Kaufman's Domains of Creativity, Schutte's Emotional Intelligence and Narcissistic Personality Inventory have been used to measure the aforementioned variables. Independent samples t-test computed using SPSS software, revealed minor difference in creativity and non-significant difference in emotional intelligence and narcissism of medical practitioners and educators. Medical practitioners' emotional intelligence and narcissism (p<0.01) showed strong positive correlation and educators' creativity positively correlated with emotional intelligence narcissism (p<0.01 and p<0.01, respectively) as per Pearson's r correlation on SPSS software.
There has been a surge in interest in and research on narcissism and narcissistic personality disorder (NPD). Despite or because of this increased attention, there are several areas of substantial debate that surround the construct, including descriptions of grandiose and vulnerable dimensions or variants, questions regarding the existence of a consensual description, central versus peripheral features of narcissism, distinctions between normal and pathological narcissism, possible etiological factors, the role of self-esteem narcissism, where narcissism should be studied, how it can be assessed, and its representation in diagnostic nosologies. We suggest that a failure to distinguish between grandiose (i.e., overtly immodest, self-centered, entitled, domineering) and vulnerable (e.g., self-centered, distrustful, neurotic, introverted) presentations of narcissism has led to a less cohesive and coherent literature and that trait-based models of personality and personality disorder can bring greater clarity to many of these important debates. Expected final online publication date for the Annual Review of Clinical Psychology Volume 13 is May 7, 2017. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Narcissism is increasingly being investigated in the context of consumer attitudes and behavior. Previous research showed that narcissism is reflected in materialistic tendencies and money-related attitudes. However, almost all of these studies concerned the grandiose type of narcissism. We examined relationships of both grandiose and vulnerable narcissism with materialism, money attitudes, and consumption preferences in a nonstudent sample. The results showed that the two types of narcissism are equally associated with materialism and a tendency to conspicuous (public) consumption. Differences between grandiose and vulnerable narcissism with regard to money attitudes were observed. Materialism mediated most of the relationships between narcissism, money attitudes, and consumption preferences, but the patterns of mediation were different for grandiose and vulnerable subtypes. Mutual suppression occurred when grandiose narcissism and materialism predicted anxiety associated with money and when vulnerable narcissism and materialism predicted money perceived as a source of evil. The results suggested that not only grandiose, but also vulnerable narcissists may be prone to excessive consumption and that this can be explained by their materialistic tendencies.
We examined whether self-esteem and narcissism predict the occurrence of stressful life events (i.e., selection) and whether stressful life events predict change in self-esteem and narcissism (i.e., socialization). The analyses were based on longitudinal data from 2 studies, including samples of 328 young adults (Study 1) and 371 adults (Study 2). The effects of self-esteem and narcissism were mutually controlled for each other and, moreover, controlled for effects of depression. After conducting the study-level analyses, we meta-analytically aggregated the findings. Self-esteem had a selection effect, suggesting that low self-esteem led to the occurrence of stressful life events; however, this effect became nonsignificant when depression was controlled for. Regardless of whether depression was controlled for or not, narcissism had a selection effect, suggesting that high narcissism led to the occurrence of stressful life events. Moreover, stressful life events had a socialization effect on self-esteem, but not on narcissism, suggesting that the occurrence of stressful life events decreased self-esteem. Analyses of trait-state models indicated that narcissism consisted almost exclusively of perfectly stable trait variance, providing a possible explanation for the absence of socialization effects on narcissism. The findings have significant implications because they suggest that a person's level of narcissism influences whether stressful life events occur, and that self-esteem is shaped by the occurrence of stressful life events. Moreover, we discuss the possibility that depression mediates the selection effect of low self-esteem on stressful life events. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
Eighty-three patients in psychodynamic psychotherapy completed the Selfobject Needs Inventory (SONI), a measure of adult attachment, a measure of working alliance, and the Symptom Checklist-Revised between the third and fifth sessions of therapy. Replicating previous nonclinical research, a positive correlation was found between avoidance of selfobject needs and adult romantic attachment avoidance. In addition, the results revealed a positive relationship between hunger for mirroring and attachment anxiety and hunger for mirroring and self-reported symptoms. As expected, there were negative correlations between avoidance of twinship needs and symptoms and avoidance of idealization and symptoms. When selfobject needs were pitted against attachment in hierarchical regression, only attachment anxiety and avoidance contributed significant variance in the prediction of symptoms. We did not find any significant relationship between selfobject needs and the early alliance. Post hoc hierarchical regression analysis revealed that selfobject needs contributed significant variance in the prediction of the therapy bond and attachment anxiety and avoidance did not. Implications of the current research are discussed along with recommendations for future study.
Despite the widely held belief that men are more narcissistic than women, there has been no systematic review to establish the magnitude, variability across measures and settings, and stability over time of this gender difference. Drawing on the biosocial approach to social role theory, a meta-analysis performed for Study 1 found that men tended to be more narcissistic than women (d = .26; k = 355 studies; N = 470,846). This gender difference remained stable in U.S. college student cohorts over time (from 1990 to 2013) and across different age groups. Study 1 also investigated gender differences in three facets of the Narcissistic Personality Inventory (NPI) to reveal that the narcissism gender difference is driven by the Exploitative/Entitlement facet (d = .29; k = 44 studies; N = 44,108) and Leadership/Authority facet (d = .20; k = 40 studies; N = 44,739); whereas the gender difference in Grandiose/Exhibitionism (d = .04; k = 39 studies; N = 42,460) was much smaller. We further investigated a less-studied form of narcissism called vulnerable narcissism-which is marked by low self-esteem, neuroticism, and introversion-to find that (in contrast to the more commonly studied form of narcissism found in the DSM and the NPI) men and women did not differ on vulnerable narcissism (d = -.04; k = 42 studies; N = 46,735). Study 2 used item response theory to rule out the possibility that measurement bias accounts for observed gender differences in the three facets of the NPI (N = 19,001). Results revealed that observed gender differences were not explained by measurement bias and thus can be interpreted as true sex differences. Discussion focuses on the implications for the biosocial construction model of gender differences, for the etiology of narcissism, for clinical applications, and for the role of narcissism in helping to explain gender differences in leadership and aggressive behavior. Readers are warned against overapplying small effect sizes to perpetuate gender stereotypes. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
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 can be expressed both overtly and covertly in patients' ways of thinking, feeling, behaving, and participating in treatment. Clinical recognition that narcissistic patients can and often do present for psychotherapy in vulnerable states of depression, anxiety, shame, and even suicidality increases the likelihood of accurate diagnosis and effective treatment planning. This article provides case examples derived from psychotherapies with narcissistic patients to demonstrate how narcissistic grandiosity and narcissistic vulnerability concurrently present in patients who seek treatment. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
This study examined the association of ringleader
bullying with psychopathic traits and theory of mind
among 100 youth aged 10–15 (62 boys and 38 girls)
receiving inpatient psychiatric services at a state facility.
Results of hierarchical multiple regression analyses indicated
a positive association between ringleader bullying
and psychopathic narcissism, and a significant interaction
effect between narcissism and theory of mind. More specifically,
narcissism moderated the relationship between
theory of mind and ringleader bullying such that theory of
mind was positively associated with ringleader bullying
when levels of narcissism were high, and theory of mind
was negatively associated ringleader bullying when levels
of narcissism were low. The discussion of these results
focuses on the importance of developing effective treatment
techniques for youth whose bullying behavior is
associated with narcissistic features and social acuity.
The current study explored the relationship between courtship violence and the exploitativeness/entitlement factor of overt
narcissism, covert narcissism, and sexual narcissism. Data were analyzed from 63 currently dating couples on their own and
partner’s aggression using the CTS2. All were white, heterosexual students from a small US college in Central Pennsylvania.
An interdependence analysis showed that correlations were entirely explained at the individual-level, thus demonstrating that
gender is a key element in understanding narcissism and courtship violence. For women, exploitativeness/ entitlement was significantly
correlated with sexual coercion in both dating partners. For men, covert narcissism was correlated with physical assault and
sexual narcissism was correlated with their partner’s sexual coercion. Narcissism also influenced some discrepancies in self-
and partner-rated aggression.
arcissism is a quality of the self that has significant implications for thinking, feeling, and behaving. Individuals with narcissistic personality possess highly inflated, unrealistically positive views of the self. Often- times, this includes strong self-focus, feelings of entitlement, and lack of regard for others. Narcissists focus on what benefits them personally, with less regard for how their actions may benefit (or harm) others. Most interesting from our perspective as self-researchers is the vast array of self-regulatory strategies used by narcissists (e.g., admiration-seeking, bragging, displaying material goods, socializing with important individuals, etc.). These strategies are both causes and consequences of narcissists' inflated self-beliefs. Our general orientation toward the narcissistic self is evident in the agency model of narcissism (Campbell, Brunell, & Finkel, 2006). As originally conceptualized, however, the agency model left out some important aspects of narcissistic self-regulation. In this chapter, we briefly review the literature on narcissism and more specifically narcissistic self-regulation. We then present an extended agency model that includes aspects of narcissistic self- regulation previously ignored by the original model. Finally, we discuss some of the current controversies surrounding narcissism in the literature.
The empirical literature on narcissistic personality disorder (NPD) is quite sparse with only a small number of studies singularly devoted to this important construct. Of the published articles on NPD, the majority (approximately 80%) are either of a theoretical nature or present data from a case study perspective. There is, however, a thriving and growing literature on trait narcissism. In comparison to NPD, trait narcissism is viewed as a continuous construct in which no attempt is made to make dichotomous decisions of a clinical nature. Recent data suggest that research on trait narcissism is relevant to NPD as self-report scores are substantially correlated with the Diagnostic and Statistical Manual of Mental Disorders (4th ed., American Psychiatric Association, 1994) interviews of NPD and generate a five-factor model personality profile that is congruent with expert ratings of prototypical NPD. We review the literature on trait narcissism in relation to implicit and explicit aspects of self-esteem, self-presentation, decision making, relationships, work performance, and externalizing behavior (e.g., aggression). Ultimately, we argue that this literature might be used as a stepping stone toward the development of a better empirical understanding of NPD and its nomological network.
We review the literature on pathological narcissism and narcissistic personality disorder (NPD) and describe a significant criterion problem related to four inconsistencies in phenotypic descriptions and taxonomic models across clinical theory, research, and practice; psychiatric diagnosis; and social/personality psychology. This impedes scientific synthesis, weakens narcissism's nomological net, and contributes to a discrepancy between low prevalence rates of NPD and higher rates of practitioner-diagnosed pathological narcissism, along with an enormous clinical literature on narcissistic disturbances. Criterion issues must be resolved, including clarification of the nature of normal and pathological narcissism, incorporation of the two broad phenotypic themes of narcissistic grandiosity and narcissistic vulnerability into revised diagnostic criteria and assessment instruments, elimination of references to overt and covert narcissism that reify these modes of expression as distinct narcissistic types, and determination of the appropriate structure for pathological narcissism. Implications for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the science of personality disorders are presented.
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 narcissism and (b) insufficient scope of existing narcissism measures. Four studies are presented documenting the initial derivation and validation of the Pathological Narcissism Inventory (PNI). The PNI is a 52-item self-report measure assessing 7 dimensions of pathological narcissism spanning problems with narcissistic grandiosity (Entitlement Rage, Exploitativeness, Grandiose Fantasy, Self-sacrificing Self-enhancement) and narcissistic vulnerability (Contingent Self-esteem, Hiding the Self, Devaluing). The PNI structure was validated via confirmatory factor analysis. The PNI correlated negatively with self-esteem and empathy, and positively with shame, interpersonal distress, aggression, and borderline personality organization. Grandiose PNI scales were associated with vindictive, domineering, intrusive, and overly-nurturant interpersonal problems, and vulnerable PNI scales were associated with cold, socially avoidant, and exploitable interpersonal problems. In a small clinical sample, PNI scales exhibited significant associations with parasuicidal behavior, suicide attempts, homicidal ideation, and several aspects of psychotherapy utilization.
Narcissistic personality disorder has received relatively little empirical attention. This study was designed to provide an empirically valid and clinically rich portrait of narcissistic personality disorder and to identify subtypes of the disorder.
A random national sample of psychiatrists and clinical psychologists (N=1,201) described a randomly selected current patient with personality pathology. Clinicians provided detailed psychological descriptions of the patients using the Shedler-Westen Assessment Procedure-II (SWAP-II), completed a checklist of axis II diagnostic criteria, and provided construct ratings for each axis II personality disorder. Descriptions of narcissistic patients based on both raw and standardized SWAP-II item scores were aggregated to identify, respectively, the most characteristic and the most distinctive features of narcissistic personality disorder.
A total of 255 patients met DSM-IV criteria for narcissistic personality disorder based on the checklist and 122 based on the construct ratings; 101 patients met criteria by both methods. Q-factor analysis identified three subtypes of narcissistic personality disorder, which the authors labeled grandiose/malignant, fragile, and high-functioning/exhibitionistic. Core features of the disorder included interpersonal vulnerability and underlying emotional distress, along with anger, difficulty in regulating affect, and interpersonal competitiveness, features that are absent from the DSM-IV description of narcissistic personality disorder.
These findings suggest that DSM-IV criteria for narcissistic personality disorder are too narrow, underemphasizing aspects of personality and inner experience that are empirically central to the disorder. The richer and more differentiated view of narcissistic personality disorder suggested by this study may have treatment implications and may help bridge the gap between empirically and clinically derived concepts of the disorder.
Five studies investigated the links among narcissism, self-esteem, and love. Across all studies, narcissism was associated primarily with a game-playing love style. This link was found in reports of general love styles (Study 1a) and of love in ongoing romantic relationships (Studies 1b-3, 5). Narcissists' game-playing love style was the result of a need for power and autonomy (Study 2) and was linked with greater relationship alternatives and lesser commitment (Study 3). Finally, narcissists' self-reports of game playing were confirmed by their partners in past and current relationships (Studies 4, 5). In contrast, self-esteem was negatively linked to manic love and positively linked to passionate love across studies. Implications for the understanding of narcissism in relationships are discussed.
This article examines the validity of grandiose and vulnerable subtypes of narcissistic character styles through an analysis of personality disorder criteria, interpersonal problems, and adult attachment styles in a nonclinical population. The grandiose personalities in this sample were rated high in the dramatic traits associated with narcissistic, antisocial, and histrionic personality disorders based on a diagnostic interview, and they reported domineering and vindictive interpersonal problems. However, despite the observation of narcissistic personality pathology, they denied interpersonal distress related to their interpersonal problems and the majority reported adult attachment styles reflective of positive self-representations (Secure, Dismissive). Vulnerable narcissistic individuals were represented by high ratings on avoidant personality disorder based on a diagnostic interview. They reported high interpersonal distress and greater domineering, vindictive, cold, and socially avoidant interpersonal problems. The majority reported adult attachment styles reflective of negative self-representations (Fearful, Preoccupied). The validity of grandiose and vulnerable narcissism based upon the results of this study was discussed in terms of clinical theory and with reference to the implications of two subtypes of narcissism for diagnosis and treatment.
Modern dating life has been changed with the advent of smartphone-based applications like Tinder. One way to identify who uses these applications is to compare the personality traits of users to non-users. In two brief studies (N = 581) we compared Tinder-users to non-users in individual differences associated with short-term mating (i.e., psychopathy, Machiavellianism, narcissism [the Dark Triad traits], and anxious attachment) and mate value. We revealed that the men who were Tinder users were especially high in psychopathy and narcissism and women who were Tinder users were especially high in anxious attachment and rated themselves as unsuccessful in finding relationship partners. While exploratory in nature, we suggest that men who are characterized by antisocial traits may use Tinder for opportunistic mating goals whereas women who have struggled to find relationships may use Tinder as a compensatory mating tactic.
Online dating continues to grow in popularity and is associated with significant advantages; however, experiencing antisocial behaviours when online dating is a distinct possibility. The aim of the current study was to explore the utility of gender and the dark personality traits of narcissism, Machiavellianism, psychopathy, and sadism in predicting perpetration of a range of antisocial behaviours on the popular dating app Tinder. It was hypothesised that the male gender and higher scores on these personality traits would predict perpetration of antisocial behaviours on Tinder. Participants (N = 587; 21% men, 79% women) completed an online questionnaire, including the Antisocial Uses of Tinder® Scale which was constructed to measure a range of antisocial behaviours. Exploratory and Confirmatory factor analyses revealed three forms of antisocial behaviours (General, esteem, and sexual) which explained over half of the variance (58.99%) of variance in the Antisocial Uses of Tinder® measure. Regression analyses were run for each form of antisocial behaviour, and the predictive utility of gender and the dark traits were found to differ across the antisocial behaviours. Results of the current study support an individual differences approach to exploring antisocial behaviours online, particularly when online dating.
Pathological narcissism is characterized by impaired interpersonal functioning, but few studies have examined the impact of the disorder on those living in a close relationship. Participants (N = 683; comprising romantic partners [77.8%], mothers [8.5%] or other family members [10%]) in a close relationship with a relative with pathological narcissism completed measures assessing levels of grief, burden, mental health, and coping style. Participants’ reported burden was over 1.5 standard deviations above comparison
carers of people with mood, neurotic, or psychotic disorders, and
higher than carers of people with borderline personality disorder. Similarly, caseness for depression (69% of sample) or anxiety disorders (82%) in the sample was high. Relationship type, subtype expression (vulnerable/grandiose), and coping style were all found to significantly relate to experienced psychopathology. Although limitations exist regarding sample selection that may influence interpretation of results, these findings quantify the significant
interpersonal impact of pathological narcissism in this sample.
Coercive control is harmful behaviour recently criminalized in England and Wales. The extent to which the work of practitioners is informed by an understanding of coercive control therefore requires investigation. Using data from two mixed methods multi-site studies, this article suggests that practitioners' recognition of coercive control does not seem to be universally poor or skilled, but rather depends on the characteristics of the situation itself, the organizational context in which practitioners work and the stage at which they are evaluating whether coercive control is present. The absence of a clear understanding of the importance of coercive control when making judgements about victims and perpetrators has serious implications for the efficacy of current approaches to domestic abuse. Purposeful and systematic efforts to support practitioners to recognize and respond effectively to coercive control are required.
Extreme altruism is defined as prosocial behavior that violates social norms or the law. Little research has been done on this phenomenon, although research into related areas suggests that, surprisingly, extreme altruistic activities may be associated with traits traditionally associated with narcissism. This relationship was explored by comparing members of the public, people involved in prosocial activities within socially and legally accepted realms, and members of the Real-Life Superhero (RLSH) movement. The RLSH movement is a subculture whose prosocial-directed activities often exceed social norms and legal constraints. These include patrolling and conducting community and citizen police work in superhero-inspired uniforms, which has on several occasions resulted in altercations with other civilians or with law enforcement. The results suggest that there is a relationship between certain traits within the narcissism spectrum and the proclivity to engage in extreme altruism. These traits include grandiose fantasy, self-sacrificing self-enhancement, and devaluing. Furthermore, these traits are expressed at significantly higher levels in people who engage in extreme altruism more often. Finally, a model based predominantly on narcissism indicated a strong ability to predict group membership among the three groups. The findings suggest that a reconceptualization that reflects the capacity of these traits to be expressed in a prosocial or antisocial behavior is needed to explain this relationship.
The main body of research on addiction and pathological narcissism has focused on the study of their co-occurrence by applying Diagnostic and Statistical Manual of Mental Disorders (DSM) definitions for these clinical phenomena or by assessing trait narcissism in substance-dependent populations. Clinically informed comprehensive conceptualizations of narcissism which focus on its phenomenological range from vulnerability to grandiosity have not been applied in studying the specific narcissistic disturbances that underlie the relationship between these comorbid conditions. Aiming to examine this relationship, this study compared the presence of pathological narcissism, and more specifically narcissistic grandiosity and vulnerability, in substance-dependent individuals in treatment with individuals from the general population. Comparisons indicate that substance-dependent individuals experience significant narcissistic disturbances more likely related to vulnerability than grandiosity. Shame, rage, and self-esteem contingent upon external validation comprise the intrapsychic and interpersonal vulnerability. Implications for the clinical conceptualization of pathological narcissism as well as for substance dependence treatment interventions are discussed.
The Handbook of Narcissism and Narcissistic Personality Disorder is the definitive resource for empirically sound information on narcissism for researchers, students, and clinicians at a time when this personality disorder has become a particularly relevant area of interest. This unique work deepens understanding of how narcissistic behavior influences behavior and impedes progress in the worlds of work, relationships, and politics.
All states have domestic violence statutes that offer legal remedies to victims of intimate partner abuse. To qualify for these remedies, the victim must demonstrate that they have been subject to certain elements of abuse. Thus, the definition of abuse under these statutes is crucial, as it determines who qualifies as a victim of abuse and as a result is afforded legal protection. Despite the clear importance of an efficient definition, the elements of abuse are outlined differently by each state. Two-thirds of states define abuse in their domestic violence statutes as criminal acts or imminent threats or acts of physical violence. Limiting the definition of abuse to purely physical acts or threats of physical acts does not address the unforgiving realities of domestic abuse. In reality, all forms of abuse—emotional, economic, and physical—are interrelated, and based on the desire for power and control. Adding the definition of coercive control can effectively address the complex issues faced by these victims. However, the definition of coercive control itself must be outlined as a gender-neutral term. Doing so will address the numerous plights faced by victims of domestic abuse and afford them the availability of the protection they deserve. This Note proposes a recognition that coercive control affects all genders and urges legislatures to adopt language based on proposed legislation in the United Kingdom that labels and defines coercive control as abuse, permitting its victims to seek legal remedies.
In the time of Freud, the typical psychoanalytic patient was afflicted with neurotic disorders; however, the modern-day psychotherapy patient often suffers instead from a variety of addictive disorders. As the treatment of neurotic disorders based on unconscious conflicts cannot be applied to treatment of addictive disorders, psychoanalysis has been unable to keep pace with the changes in the type of patient seeking help. To address the shift and respond to contemporary patients' needs, Ulman and Paul present a thorough discussion of addiction that studies and analyzes treatment options. Their honest and unique work provides new ideas that will help gain access to the fantasy worlds of addicted patients. The Self Psychology of Addiction and Its Treatment emphasizes clinical approaches in the treatment of challenging narcissistic patients struggling with the five major forms of addiction. Ulman and Paul focus on six specific case studies that are illustrative of the five forms of addiction. They use the representative subjects to develop a self psychological model that helps to answer the pertinent questions regarding the origins and pathway of addiction. This comprehensive book links addiction and trauma in an original manner that creates a greater understanding of addiction and its foundations than any clinical or theoretical model to date.
The narcissistic personality disorder presents, clinically, at three levels of severity. The mildest cases, who appear “neurotic,” usually present indications for psychoanalysis. They typically do consult only because of a significant symptom, which seems so linked to their character pathology that anything but the treatment of their personality disorder would seem inadequate. In contrast, other narcissistic patients at that level present symptoms that may be treated without an effort to modify or resolve their narcissistic personality structure. All of these patients seem to be functioning in general, except they typically present with significant problems in long-term intimate relationships and in long-term professional or work interactions.
ABOUT THE AUTHOR
Otto F. Kernberg, MD is Director, Personality Disorders Institute, The New York Presbyterian Hospital, Westchester Division; Professor of Psychiatry, Joan and Sanford I. Weill Medical College of Cornell University; and Training and Supervising Analyst, Columbia University Center for Psychoanalytic Training and Research.
The work reported in this paper was supported by the Borderline Personality Disorders Research Foundation and its founder, Dr. Marco Stoffel, to whom the author wishes to express his profound gratitude.
The psychological phenomenon labeled Stockholm syndrome or trauma bonding has been explained as a product of interpersonal trauma whereby the perpetrator elicits fear in the victim that is experienced as venerating gratitude for being allowed to survive. There is no widely accepted theory to explain how perpetrators of trauma emotionally bind their victims to them; however, the general phenomenon of victims developing emotional attachments to their abusers or captors has been observed in situations of intimate partner violence, child abuse, hostage situations, human trafficking, and cults. Despite repeated observations of trauma bonding in victims of interpersonal violence, little research exists regarding its formation or persistence and even less is known about positive resolution in survivors. The chapter begins by presenting the existing theoretical conceptualizations and research findings on trauma bonding along with complexities of intervention and treatment within several diverse contexts. The chapter features those situations or settings which are primarily characterized by interpersonal violence. Next, the chapter reviews critical concerns regarding methodological weaknesses of previous research focused on trauma bonding and recommends several potential avenues for integrated theory and research. Lastly, implications for policy related to trauma bonding within the field of interpersonal violence are explored.
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We propose a dynamic self-regulatory processing model of narcissism and review supporting evidence. The model casts narcissism in terms of motivated self-construction, in that the narcissist's self is shaped by the dynamic interaction of cognitive and affective intrapersonal processes and interpersonal self-regulatory strategies that are played out in the social arena. A grandiose yet vulnerable self-concept appears to underlie the chronic goal of obtaining continuous external self-affirmation. Because narcissists are insensitive to others' concerns and social constraints and view others as inferior, their self-regulatory efforts often are counterproductive and ultimately prevent the positive feedback that they seek-thus undermining the self they are trying to create and maintain. We draw connections between this model and other processing models in personality and employ these models to further elucidate the construct of narcissism. Reconceptualizing narcissism as a self-regulatory processing system promises to resolve many of its apparent paradoxes, because by understanding how narcissistic cognition, affect, and motivation interrelate, their internal subjective logic and coherence come into focus.
As a means for presenting Sartre's insights into the narcissistic problems of the self, we have used his phenomenological system as articulated in Being and Nothingness (1943) to illuminate these issues in the personality of Roquentin, the hero of his novel Nausea (1938). Roquentin attempts to stabilize his fragmenting self and to avoid "nausea" by using three mechanisms which Sartre argues maintain the self from drowning in the objects of the self. These are "reflection," "temporality" (continuity through time), and "being-for-others" (how we experience another's view of ourselves). In Sartre's conception of being-for-others lies many clinically useful insights which can be used to explain both the structure and the instability of the transferences seen in the treatment of narcissistic personality disorders. Sartre demonstrates by implication that the patient must maintain (by using bad faith, i.e., disavowal) that the therapist is acting freely, or these transferences collapse. Thus, the patient must feel he is the unique and special "occasion," of any warmth, empathy, or compliments. A case example is included to illustrate these issues of freedom and bad faith.
Narcissistic defects are often associated with the use of habitual defensive operations in which meanings are shifted in order to protect the self-concept. Such cognitive maneuvers, used as a character style, not only protect against threatening ideas and emotional responses, but also lead to a constellation of traits and patterns of relationship that constitute a narcissistic personality disorder. Reconstruction, with clear designations of a self-as-actor, are useful in the psychotherapy of such persons provided that these reconstructions are done with the utmost tact and concern for maintenance of the therapeutic relationship.
The development of narcissism is usually studied from the standpoint of the drives, or more specifically of the libido. This paper considers narcissism from the standpoint of the ego and seeks to delineate separate developmental lines. From this point of view, a variety of forms may be distinguished which are ordinarily structured during the oedipal period. It is postulated that narcissism cannot be considered as truly separable from the vicissitudes of the love and hate of objects. This formulation makes possible consideration of recent observations concerning the 'narcissistic personality' without requiring major new economic, structural, or dynamic metapsychological constructs.
In many cases addictive behavior serves to ward off a sense of helplessness or powerlessness via controlling and regulating one's affective state. Addicts have a vulnerability to feelings of powerlessness, which reflects a specific narcissistic impairment. The drive in addiction to re-establish a sense of power is, correspondingly, impelled by narcissistic rage. This rage gives to addiction some of its distinctive clinical properties. The narcissistic vulnerability in addicts is discussed. Several brief clinical cases are provided, and the view proposed is correlated with other psychoanalytic perspectives.
We examined the internal and external validity of the Narcissistic Personality Inventory (NPI). Study 1 explored the internal structure of the NPI responses of 1,018 subjects. Using principal-components analysis, we analyzed the tetrachoric correlations among the NPI item responses and found evidence for a general construct of narcissism as well as seven first-order components, identified as Authority, Exhibitionism, Superiority, Vanity, Exploitativeness, Entitlement, and Self-Sufficiency. Study 2 explored the NPI's construct validity with respect to a variety of indexes derived from observational and self-report data in a sample of 57 subjects. Study 3 investigated the NPI's construct validity with respect to 128 subject's self and ideal self-descriptions, and their congruency, on the Leary Interpersonal Check List. The results from Studies 2 and 3 tend to support the construct validity of the full-scale NPI and its component scales.
It appears very likely that it is the convergence of at least some, if not all, of 6 elements, massive defect of affect defense, the defect in value formation, the hyposymbolization, the desperate search for an object substitute, the intensely self destructive qualities, and the search for regressive gratification, together with the intensity of the underlying narcisstic conflicts that forms the predispositional constellation for the 'addictive illness' in general and for compulsive drug use in particular. It appears that the most specific of these predispositional factors are the need for affect defense and the compelling wish for regressive gratification; but only further research, including predictive studies, can elucidate the relative relevance of these 6 factors. The specific reason is the mobilization of the underlying narcisstic conflict. The precipitating reason is the advent of the drug on stage. Some or all of the 6 predispositional factors described may be necessary reasons.
This study describes the construction of scales designed to assess ambitious-narcissistic character style on three projective tests: the Early Memories, TAT, and Rorschach. The main aim of the study was to evaluate the reliability and validity of these scales. A secondary aim was to demonstrate the feasibility of assessing particular character styles with projective tests commonly available to clinicians and researchers. Forty male college students volunteered as subjects. The overall reliability of the three projective scales was found to be acceptable. The scales were then tested for validity in two ways. First, they were intercorrelated and found to show a pattern suggesting a common dimensionality. Secondly, the scales were found to successfully differentiate subjects rated by clinically-trained raters as ambitious-narcissistic in style from those subjects rated as non-ambitious-narcissistic.
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 or vulnerable affects and self-states. Recent research in social/personality psychology examining the structure of narcissistic personality traits consistently finds two broad factors representing Grandiosity-Exhibitionism and Vulnerability-Sensitivity-Depletion respectively. However, the majority of psychiatric criteria for narcissistic personality disorder (NPD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) emphasize expressions of grandiosity. By placing most of the diagnostic emphasis on overt grandiosity, DSM NPD has been limited by poor discriminant validity, modest levels of temporal stability, and the lowest prevalence rate on Axis II. Despite converging support for two phenotypic themes associated with pathological narcissism, psychiatric diagnosis and social/personality psychology research often focus only on grandiosity in the assessment of narcissism. In contrast, clinical theory struggles with a proliferation of labels describing these broad phenotypic variations. We conclude that the construct of pathological narcissism is at a crossroads and provide recommendations for diagnostic assessment, clinical conceptualization, and future research that could lead to a more integrated understanding of narcissistic personality and narcissistic personality pathology.
Diagnostic and statistical manual of mental disorders
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed.). Washington, DC: Author.