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Emergence of an Abnormal Personality
Abstract
There are ten types of personality disorders (PDs). The overall prevalence of these in the United States of America is highest for obsessive–compulsive PD (OCPD) followed by narcissistic PD (NPD) and borderline PD (BPD). PDs are strongly correlated with mental health disorders such as depression, anxiety, and substance abuse, and they have in common a failure in impulse control.
NPD is principally determined by the social environment and is composed of two different forms, the grandiose and the vulnerable, both of which involve the search for admiration to satisfy feelings of importance. The personality features of vulnerable narcissistic patients, especially shame and rumination, lend themselves to exacerbating depression. The psychodynamic personality theories of Kohut and Kernberg stress the effects of emotional abuse and neglect in childhood that give rise to the child developing a compensatory grandiose self-image and so the emergence of NPD.
BPD is characterised by occasions of unreality, frequent changes in self-image, changes in mood, outbursts of anger, and dangerous acts of self-injury, of suicide attempts, and of suicide. Both inherited and environmental risk factors are independently responsible for the aetiology of this disorder. Trauma in child–parent relationships involving abuse, assault, neglect, violence, exploitation, or bullying are all strong predicators for BPD emerging between adolescence and 30 years of age.
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The present study examines the lack of strong correlations among existing self-report measures of narcissism. A principal-components analysis of 6 MMPI narcissism scales resulted in 2 orthogonal factors, 1 implying Vulnerability–Sensitivity and the other Grandiosity–Exhibitionism. Although unrelated to each other, these 2 factors were associated with such core features of narcissism as conceit, self-indulgence, and disregard of others. Despite this common core, however, Vulnerability–Sensitivity was associated with introversion, defensiveness, anxiety, and vulnerability to life's traumas, whereas Grandiosity–Exhibitionism was related to extraversion, self-assurance, exhibitionism, and aggression. Three alternative interpretations of these results are considered, and an argument for the distinction between covert and overt narcissism is made.
Objective
In 2019, for the first time, Delaware collected adverse childhood experiences (ACEs) data through the population-based Behavioral Risk Factor Surveillance System (BRFSS). The main objective of this study was to explore and delineate the prevalence of ACEs and determine their association with select chronic conditions/risk behaviors.
Study design
A cross-sectional population-based study.
Methods
Delaware BRFSS 2019 data (N = 3,879) were analyzed. This includes 2,015 respondents with at least one ACE and 1,882 without ACE. Logistic regression was performed using SAS complex weighting procedures to compare the prevalence odds of selected conditions while controlling for age, gender, and race/ethnicity in Delawareans with and without ACEs. Delaware BRFSS participant response rate was 38.2% comparable to other federal survey responses.
Results
Nearly one in four adults reported high ACEs scores (≥3). Emotional abuse was the most common ACE. ACEs were significantly associated with poorer health outcomes. High ACE scores were more prevalent among women, multiracial/minority race groups, bisexual, lesbian/gay sexually oriented, younger age group, and less educated. Associations between high ACEs score and selected health conditions/behaviors remained statistically significant even after controlling for socio-demographic characteristics.
Conclusion
Reporting of ACEs data is critical for Delaware's progress towards a Trauma-Informed State. A particularly disturbing finding was that a high number of young adults reported 3 or more ACEs. Strong association with chronic conditions, particularly mental health was a significant cause for concern. Study results present a first-time expansive coverage, providing stakeholders with a unique opportunity to prioritize evidence-based decisions in Trauma-Informed Delaware.
Personality disorders (PDs) exert a great toll on health resources, and this is especially true for borderline personality disorder (BPD). As all PDs, BPD arises during adolescence or young adulthood. It is therefore important to detect the presence of this PD in its earlier stages in order to initiate appropriate treatment, thus ameliorating the prognosis of this condition. This review aims to highlight the issues associated with BPD diagnosis in order to promote its early detection and treatment. To do so, we conducted a search on PubMed database of current evidence regarding BPD early diagnosis, focusing on risk factors, which represent important conditions to assess during young patient evaluation, and on diagnostic tools that can help the clinician in the assessment process. Our findings show how several risk factors, both environmental and genetic/neurobiological, can contribute to the onset of BPD and help identify at-risk patients who need careful monitoring. They also highlight the importance of a careful clinical evaluation aided by psychometric tests. Overall, the evidence gathered confirms the complexity of BDP early detection and its crucial importance for the outcome of this condition.
Background
Research on personality pathology in adolescence has accelerated during the last decade. Among all of the personality disorders, there is strong support for the validity of borderline personality disorder (BPD) diagnosis in adolescence with comparable stability as seen in adulthood. Researchers have put much effort in the analysis of the developmental pathways and etiology of the disorder and currently are relocating their attention to the identification of the possible risk factors associated with the course of BPD symptoms during adolescence. The risk profile provided in previous systematic reviews did not address the possible development and course of BPD features across time. Having this in mind, the purpose of this systematic review is to identify the factors that are associated with the course of BPD symptoms during adolescence.
Methods
Electronic databases were systematically searched for prospective longitudinal studies with at least two assessments of BPD as an outcome of the examined risk factors. A total number of 14 articles from the period of almost 40 years were identified as fitting the eligibility criteria.
Conclusions
Factors associated with the course of BPD symptoms include childhood temperament, comorbid psychopathology, and current interpersonal experiences. The current review adds up to the knowledge base about factors that are associated with the persistence or worsening of BPD symptoms in adolescence, describing the factors congruent to different developmental periods.
Child sexual abuse (CSA) is a crime against human rights with severe health consequences, and suicidal actions, stress, eating disorders, and borderline disorder are common among survivors of CSA. The objective of this study was to analyze how health care consumption patterns developed among adolescent girls in the Stockholm Region, Sweden, 1 and 2 years after the first registration of CSA experience appeared in their medical record, as compared to age-matched controls without such registration. In this cohort study, number of healthcare visits, comorbidities, and prescribed drugs were collected through the Stockholm Region administrative database (VAL), for girls age 12-17 with registration of CSA experience in their medical record (n = 519) and age-matched controls (n = 4920) between 2011 and 2018. Healthcare consumption patterns remained higher among the girls with a registered CSA experience compared to the controls, both 1 and 2 years after the first CSA experience registration. Highest odds ratios (ORs) were found for suicide attempts [OR 26.38 (12.65-55.02) and 6.93 (3.48-13.49)]; stress disorders [25.97 (17.42-38.69) and 15.63 (9.82-24.88)]; psychosis [OR 19.39 (1.75-214.13) and 9.70 (1.36-68.95)], and alcohol abuse [OR 10.32 (6.48-16.44) and 6.09 (1.98-18.67)], 1 and 2 years, respectively, after the first CSA experience registration. The drug prescriptions were also significantly higher among the girls with a CSA experience registration than for the controls. The results highlight the need to systematically evaluate and develop assessment, treatment planning, and interventions offered to adolescent girls after their first CSA experience registration.
Background:
Elevated narcissism in young people often sets up a cascade of interpersonal and mental health challenges, reinforcing the need to understand its concomitants. Experiences of maltreatment and different parenting styles have been implicated but findings to date are inconclusive. By simultaneously considering multiple remembered parenting styles and maltreatment in a large sample, this study aims to elucidate possible prognostic factors associated with both grandiose and vulnerable narcissistic traits in youth.
Methods:
Young people (N = 328, age range: 17-25 years) reported on the remembered interpersonal environment and current grandiose and vulnerable narcissism traits. Structural equation modelling was used to examine maternal and paternal parenting styles and examine the association between experiences of parenting and grandiose and vulnerable narcissism.
Results:
Remembered overprotection from mothers and fathers was associated with both vulnerable and grandiose narcissistic traits. Remembered maternal overvaluation related to current grandiosity, and maternal leniency related to vulnerable narcissistic traits. For paternal parenting, the combination of overvaluation and leniency and overvaluation and care explained grandiose and vulnerable traits. There was no direct effect of remembered parental care or childhood maltreatment on current levels of narcissistic traits.
Conclusions:
Remembered childhood experiences of being overprotected, overvalued and experiencing leniency in parental discipline, were associated with higher traits of pathological narcissism in young people. Care and maltreatment were non-specific risk factors. Remembered childhood environments of being excessively pampered are associated with grandiose and vulnerable narcissistic traits, characterised by the young person expressing unrealistic self-views, entitlement beliefs and impaired autonomy. In treatment these traits may emerge in the patient-therapist relationship and working through their developmental origins may contribute to outcomes.
Background/Objectives
Maladaptive parenting (including childhood maltreatment, abuse and neglect) has been implicated in the scientific literature exploring the aetiology of personality disorder, particularly borderline personality disorder (BPD). Our primary objective was to summarise the evidence on the relationship between parenting and personality disorder, assisting clinical decision-makers to translate this research into clinical policy and practice.
Methods
We conducted an overview of systematic reviews that assessed individuals with personality disorder pathology for experiences of maladaptive parenting, compared to psychiatric or healthy comparisons/controls, and the impact on psychopathological and relational outcomes. Systematic literature searches were conducted in Scopus, Web of Science, MEDLINE, PsycINFO, and by hand in August 2018. Methodological quality was assessed using the CASP systematic review checklist, and results were qualitatively synthesised. A pre-determined protocol was registered in Prospective Register of Systematic Reviews (PROSPERO 2019:CRD42018096177).
Results
Of the 312 identified records, 293 abstracts were screened, 36 full-text articles were retrieved and eight systematic reviews met pre-determined criteria for qualitative synthesises. The majority of studies reported outcomes related to BPD (n = 7), and study design, methodology and quality varied. Within the eight systematic reviews there were 211 primary studies, of which 140 (66.35%) met eligibility criteria for inclusion in this overview. Eligible primary studies reported on 121,895 adult, child/adolescent and parent-offspring participants, with most studies focused on borderline personality pathology (n = 100, 71.43%). Study design and methodology also varied for these studies. Overall, five systematic reviews overwhelming found that maladaptive parenting was a psychosocial risk factor for the development of borderline personality pathology, and three studies found that borderline personality pathology was associated with maladaptive parenting, and negative offspring and parenting-offspring outcomes.
Conclusions
In light of these findings, we recommend greater emphasis on parenting in clinical practice and the development of parenting interventions for individuals with personality disorder. However, our understanding is limited by the heterogeneity and varying quality of the evidence, and as such, future research utilising more rigorous research methodology is needed.
Rejection sensitivity (RS) is one the of core features of borderline personality disorder (BPD). The cognitive-affective personality system (CAPS) might represent an alternative framework for analyzing the relationship between RS and BPD. The current meta-analytic review (N = 39 studies) aims at evaluating how, and to what extent, CAPS-RS process dynamics (i.e., rejection expectancies, encoding processes, and affect reactions) are related to BPD. The results showed a large difference between BPD and non-BPD subjects in rejection expectancies across several situations. These findings were replicated when considering encoding processes and affective reactions, especially in relation to social inclusion situations. Therefore, it can be argued that RS process dynamics might reflect CAPS principles explaining personality pathology, especially BPD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Research on narcissists’ explicit self-esteem (ESE) and implicit self-esteem (ISE) is characterized by a wide array of competing hypotheses and inconsistent empirical findings. Using data from 18 samples (total N = 5,547), we moved beyond classical null-hypothesis testing and employed an information-theoretic approach combined with Response Surface Analysis to provide a first competitive test of all plausible ESE-ISE combinations for different aspects of narcissism and across a wide set of ISE measures. Agentic and communal narcissism were positively, neurotic and antagonistic narcissism were negatively related to ESE. Contradicting the mask model and other more complex models, no consistent evidence was found for relations between narcissism and ISE, and ESE-ISE discrepancies, respectively. Implications for understanding narcissistic self-regulatory dynamics are discussed.
Borderline personality disorder (BPD) is a chronic psychiatric disorder characterized by pervasive affective instability, self-image disturbances, impulsivity, marked suicidality, and unstable interpersonal relationships as the core dimensions of psychopathology underlying the disorder. Across a wide range of situations, BPD causes significant impairments. Patients with BPD suffer considerable morbidity and mortality compared with other populations. Although BPD is more widely studied than any other personality disorder, it is not understood sufficiently. This paper briefly reviews the recent evidence on the prevalence, etiology, comorbidity, and treatment approaches of borderline personality disorder (BPD) by examining published studies, and aims to offer a more coherent framework for the understanding and management of borderline personality disorder.
Narcissists' threat reactivity can be differentiated into cognitive, emotional, and tactical-behavioral responses, and these dimensions of reactivity are presumed to vary as a function of grandiose and vulnerable narcissism. The present research applied this conceptual model to situations involving a relationship threat from a rival. A college sample completed measures of vulnerable narcissism, pathological and non-pathological measures of grandiose narcissism, and then indicated anticipated cognitive, emotional, and tactical responses to situations involving high and low levels of rival threat. All narcissism forms generally converged on similar tactical responses - specifically, enhanced coercive and mate-value-enhancement tactics. Yet, both pathological and non-pathological expressions of grandiose narcissism diverged from vulnerable narcissism on cognitive and emotional outcomes, such that only vulnerable narcissism related to enhanced worrying and negative emotionality. Furthermore, all narcissism forms were more strongly related to coercive tactics against the rival following high (vs. low) rival threat.
This study reevaluates the factor structure of the Selfobject Needs Inventory (SONI) using a sample of 738 students at an ethnically diverse urban university. The original SONI comprises 5 factors corresponding to approach and avoidance of Kohut’s selfobject needs for mirroring, idealization, and twinship. The current factor analysis revealed 4 factors related to individuals’ needs for affiliation and self-efficacy and indicating conflict around meeting these needs. Relationships between the new SONI factors and attachment style, narcissistic traits in adulthood, and childhood maltreatment were examined for convergent validity with the SONI and to clarify the underlying interpersonal needs of narcissistic variants and potential relationships with childhood trauma. Our results are consistent with Kohut’s conceptualization of narcissism as related to childhood emotional abuse and neglect and more closely related to the vulnerable variant of the narcissistic personality than the grandiose variant. Conflict surrounding selfobject needs may impede the ability to effectively use others to self-regulate, resulting in poorer interpersonal functioning and greater symptomatology than individuals who experience less conflict around using others to meet these needs. Clinical and research utility of the SONI are discussed.
Narcissism scores are higher in individualistic cultures compared with more collectivistic cultures. However, the impact of sociocultural factors on narcissism and self-esteem has not been well described. Germany was formerly divided into two different social systems, each with distinct economic, political and national cultures, and was reunified in 1989/90. Between 1949 and 1989/90, West Germany had an individualistic culture, whereas East Germany had a more collectivistic culture. The German reunification provides an exceptional opportunity to investigate the impact of sociocultural and generational differences on narcissism and self-esteem. In this study, we used an anonymous online survey to assess grandiose narcissism with the Narcissistic Personality Inventory (NPI) and the Pathological Narcissism Inventory (PNI) to assess grandiose and vulnerable aspects of narcissism, and self-esteem with the Rosenberg Self-Esteem Scale (RSE) in 1,025 German individuals. Data were analyzed according to age and place of birth. Our results showed that grandiose narcissism was higher and self-esteem was lower in individuals who grew up in former West Germany compared with former East Germany. Further analyses indicated no significant differences in grandiose narcissism, vulnerable narcissism or self-esteem in individuals that entered school after the German reunification (≤ 5 years of age in 1989). In the middle age cohort (6–18 years of age in 1989), significant differences in vulnerable narcissism, grandiose narcissism and self-esteem were observed. In the oldest age cohort (> 19 years of age in 1989), significant differences were only found in one of the two scales assessing grandiose narcissism (NPI). Our data provides empirical evidence that sociocultural factors are associated with differences in narcissism and self-esteem.
OBJECTIVES: In this present study, we aimed to examine the relationship between impulsivity and attention-deficit/hyperactivity symptoms in female patients with borderline personality disorder (BPD) and compare these symptoms with a healthy group.
METHODS: The sample of this study was composed of randomly selected 90 female patients diagnosed with BPD according to Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-5) criteria and not receiving any medical treatment during the past six months since presented to the Bagcilar Training and Research Hospital and randomly selected 90 healthy controls who were free of any psychiatric disorders. Semi-structured sociodemographic data form, Adult ADHD Self-Report Scale (ASRS-v1.1), and Barratt Impulsiveness Scale (BIS-11) were administered.
RESULTS: Total BIS scores were statistically significantly correlated with total ASRS (r = .557, p < .001) and its two subscales: Inattention (r = .593, p < .001) and Hyperactivity/Impulsivity (r = .399, p < .001). The results of Chi-square test revealed a statistically significant difference in terms of being diagnosed with attention-deficit/hyperactivity disorder (ADHD) or not between patient and healthy group (χ² = 46.667, df = 1, p = .000). Furthermore, there was a statistically significant difference between the patients and the healthy controls in terms of total BIS-11 [t(178) = 10.444, p = .000] and total ASRS [t(178) = 9.697, p = .000]. The results of hierarchical multiple regression revealed that Motor subscale scores were significantly predictive of ASRS scores [R² = .337, F(6,82) = 5.960, p = .00].
CONCLUSIONS: In this present study, patients with BPD had higher rates of comorbid ADHD and impulsivity scores than healthy controls. ASRS scores and BIS scores were positively correlated, and motor subscale scores were significantly predictive of ASRS scores.
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.
There is evidence for differential stability in personality trait differences, even over decades. The authors used data from a sample of the Scottish Mental Survey, 1947 to study personality stability from childhood to older age. The 6-Day Sample (N = 1,208) were rated on six personality characteristics by their teachers at around age 14. In 2012, the authors traced as many of these participants as possible and invited them to take part in a follow-up study. Those who agreed (N = 174) completed a questionnaire booklet at age 77 years, which included rating themselves and asking someone who knew them well to rate them on the same 6 characteristics on which they were rated in adolescence. Each set of 6 ratings was reduced to the same single underlying factor, denoted dependability, a trait comparable to conscientiousness. Participants’ and others’ older-age personality characteristic ratings were moderately correlated with each other, and with other measures of personality and wellbeing, but correlations suggested no significant stability of any of the 6 characteristics or their underlying factor, dependability, over the 63-year interval. However, a more complex model, controlling rater effects, indicated significant 63-year stability of 1 personality characteristic, Stability of Moods, and near-significant stability of another, Conscientiousness. Results suggest that lifelong differential stability of personality is generally quite low, but that some aspects of personality in older age may relate to personality in childhood.
Objective:
We aimed to describe the prevalence and age distribution of personality disorders and their comorbidity with other psychiatric disorders in an age-stratified sample of Australian women aged ⩾25 years.
Methods:
Individual personality disorders (paranoid, schizoid, schizotypal, histrionic, narcissistic, borderline, antisocial, avoidant, dependent, obsessive-compulsive), lifetime mood, anxiety, eating and substance misuse disorders were diagnosed utilising validated semi-structured clinical interviews (Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition and Structured Clinical Interview for DSM-IV Axis II Personality Disorders). The prevalence of personality disorders and Clusters were determined from the study population (n = 768), and standardised to the Australian population using the 2011 Australian Bureau of Statistics census data. Prevalence by age and the association with mood, anxiety, eating and substance misuse disorders was also examined.
Results:
The overall prevalence of personality disorders in women was 21.8% (95% confidence interval [CI]: 18.7, 24.9). Cluster C personality disorders (17.5%, 95% CI: 16.0, 18.9) were more common than Cluster A (5.3%, 95% CI: 3.5, 7.0) and Cluster B personality disorders (3.2%, 95% CI: 1.8, 4.6). Of the individual personality disorders, obsessive-compulsive (10.3%, 95% CI: 8.0, 12.6), avoidant (9.3%, 95% CI: 7.1, 11.5), paranoid (3.9%, 95% CI: 3.1, 4.7) and borderline (2.7%, 95% CI: 1.4, 4.0) were among the most prevalent. The prevalence of other personality disorders was low (⩽1.7%). Being younger (25-34 years) was predictive of having any personality disorder (odds ratio: 2.36, 95% CI: 1.18, 4.74), as was being middle-aged (odds ratio: 2.41, 95% CI: 1.23, 4.72). Among the strongest predictors of having any personality disorder was having a lifetime history of psychiatric disorders (odds ratio: 4.29, 95% CI: 2.90, 6.33). Mood and anxiety disorders were the most common comorbid lifetime psychiatric disorders.
Conclusions:
Approximately one in five women was identified with a personality disorder, emphasising that personality disorders are relatively common in the population. A more thorough understanding of the distribution of personality disorders and psychiatric comorbidity in the general population is crucial to assist allocation of health care resources to individuals living with these disorders.
The purpose of this research is to better illuminate a vulnerable narcissist's daily emotional life, targeting the experiences of shame, anger, and emotion regulation. Participants completed self-report questionnaires before writing an essay on their adjustment to college. After being randomly assigned to receive either satisfactory or unsatisfactory feedback, participants rated the quality of their own essay performance, reported their current emotions, and completed extra process measures to assess what they were thinking during the study. Feedback which dis-confirmed vulnerable narcissists' self-reported performance ratings led to greater emotionality. Furthermore, vulnerable narcissists' intention to regulate their emotions, specifically their attempts to disqualify the importance of interpersonal feedback, ultimately led to greater shame. Conceptual and practical implications of these findings are discussed.
Purpose
To investigate the personality disorders (PDs) diagnosed in patients with depressive disorders.
Material and methods
This study included a cross-sectional analysis, and was an extension of the Thai Study of Affective Disorder (THAISAD) project. Eighty-five outpatients with depressive disorders were interviewed using the Mini International Neuropsychiatric Inventory to assess for depression, in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision and using the Thai version of the Structured Clinical Interview for PDs to assess for PD.
Results
Seventy-seven percent of the patients had at least one PD, 40% had one PD and 60% had two or more PDs (mixed cluster). The most common PDs found were borderline PD (20%) and obsessive–compulsive PD (10.6%), while the occurrence of avoidant PD was low when compared to the findings of previous, related studies. Among the mixed cluster, cluster A combined with cluster C was the common mix. Both dysthymic disorder and double depression were found to have a higher proportion of PDs than major depressive disorder (85.7% versus 76.1%). Dependent PD was found to be less common in this study than in previous studies, including those carried out in Asia.
Conclusion
The prevalence of PDs among those with depressive disorder varied, and only borderline PD seems to be consistently high within and across cultures. Mixed cluster plays a prominent role in depression, so more attention should be paid to patients in this category.
Complex PTSD (cPTSD) was formulated to include, in addition to the core PTSD symptoms, dysregulation in three psychobiological areas: (1) emotion processing, (2) self-organization (including bodily integrity), and (3) relational security. The overlap of diagnostic criteria for cPTSD and borderline personality disorder (BPD) raises questions about the scientific integrity and clinical utility of the cPTSD construct/diagnosis, as well as opportunities to achieve an increasingly nuanced understanding of the role of psychological trauma in BPD. We review clinical and scientific findings regarding comorbidity, clinical phenomenology and neurobiology of BPD, PTSD, and cPTSD, and the role of traumatic victimization (in general and specific to primary caregivers), dissociation, and affect dysregulation. Findings suggest that BPD may involve heterogeneity related to psychological trauma that includes, but extends beyond, comorbidity with PTSD and potentially involves childhood victimization-related dissociation and affect dysregulation consistent with cPTSD. Although BPD and cPTSD overlap substantially, it is unwarranted to conceptualize cPTSD either as a replacement for BPD, or simply as a sub-type of BPD. We conclude with implications for clinical practice and scientific research based on a better differentiated view of cPTSD, BPD and PTSD.
Significance
Narcissistic individuals feel superior to others, fantasize about personal successes, and believe they deserve special treatment. When they feel humiliated, they often lash out aggressively or even violently. Unfortunately, little is known about the origins of narcissism. Such knowledge is important for designing interventions to curtail narcissistic development. We demonstrate that narcissism in children is cultivated by parental overvaluation: parents believing their child to be more special and more entitled than others. In contrast, high self-esteem in children is cultivated by parental warmth: parents expressing affection and appreciation toward their child. These findings show that narcissism is partly rooted in early socialization experiences, and suggest that parent-training interventions can help curtail narcissistic development and reduce its costs for society.
The pervasive effect of personality disorder is often overlooked in clinical practice, both as an important moderator of mental state and physical disorders, and as a disorder that should be recognised and managed in its own right. Contemporary research has shown that maladaptive personality (when personality traits are extreme and associated with clinical distress or psychosocial impairment) is common, can be recognised early in life, evolves continuously across the lifespan, and is more plastic than previously believed. These new insights offer opportunities to intervene to support more adaptive development than before, and research shows that such intervention can be effective. Further research is needed to improve classification, assessment, and diagnosis of personality disorder across the lifespan; to understand the complex interplay between changes in personality traits and clinical presentation over time; and to promote more effective intervention at the earliest possible stage of the disorder than is done at present. Recognition of how personality disorder relates to age and developmental stage can improve care of all patients.
Copyright © 2015 Elsevier Ltd. All rights reserved.
Background
In the development of narcissism, besides genetic factors, hostile educational conditions, including adverse childhood experiences (ACEs), are discussed as causal factors. ACE may play a causal role in the development of antagonistic behavior due to negative interpersonal experiences. However, studies assessing the role of ACEs in the etiology of narcissism are still inconsistent, particularly regarding grandiose narcissism. This may be due to the complexity of grandiose narcissism, which can be distinguished into agentic (admiration) and antagonistic (rivalry) facets. Understanding the role of early traumatic events in the etiology of grandiose narcissism may be important for psychotherapeutic treatment in both, patients with trauma history and narcissistic patients.
Objective
We aimed to specify the role of ACEs in grandiose narcissism by differentiating between admiration and rivalry.
Participants and setting
In a cross-sectional survey conducted from November 2017 to February 2018, a representative sample of the German population above the age of 14 (N = 2531) was selected in a random route approach.
Results
Increased numbers of ACEs were associated with higher mean scores for rivalry in females (B = 0.04, p = 0.02) and males (B = 0.08, p < 0.01), while no significant associations were seen for admiration. Focusing on individual ACEs, in males, all maltreatment experiences were associated with narcissistic rivalry, with the exception of physical neglect, while in women only emotional maltreatment and emotional neglect were significant. Associations with household dysfunction were shown only in men. There were no significant associations between individual ACEs and admiration.
Conclusions
Our results suggest emotional coldness and negative relationship experiences play a role in the development of, in particular, antagonistic and unfavorable narcissistic traits, such as admiration. Therapy with individuals who have experienced ACEs should take into account possible narcissistic personality traits related to ACEs to facilitate successful treatment. Thus, our findings may help building a therapeutic alliance though a better understanding of the development of current behavioral problems for both patient and psychotherapist.
Background
To date, numerous cohort studies and meta-analyses have shown that childhood maltreatment is associated with a wide range of adverse physiological and psychological symptoms. Although childhood maltreatment has been linked to an increased risk of personality disorders, the direction and magnitude of the association remain uncertain. Therefore, this cohort study aimed to evaluate whether children who have suffered childhood maltreatment have a higher incidence of subsequent personality disorders, using a nationwide database in Taiwan.
Methods
We conducted a large retrospective cohort study using data drawn from Taiwan's National Health Insurance Research Database between 2000 and 2015. A total of 10,345 children who experienced childhood maltreatment were identified using International Classification of Disease codes. They were then compared with 41,380 children who never experienced childhood maltreatment in terms of the prevalence rates of personality disorders.
Results
Childhood maltreatment was associated with an increased risk of personality disorders (considering the control as reference: adjusted hazard ratio, 2.12; 95 % confidence interval, 1.90–2.36; p<0.001). The Kaplan-Meier analysis revealed a significantly higher 15-year cumulative incidence of personality disorders among childhood maltreatment victims than among controls (log-rank test, p<0.001).
Conclusions
The present population-based study showed a positive association between prior childhood maltreatment and subsequent personality disorders in the general Taiwanese population. In order to reduce the risk of personality disorders, interventions should be implemented, identifying and supporting economically disadvantaged families and vulnerable children as early as possible.
Borderline personality disorder (BPD) is a mental disorder with a high burden on patients, family members, and health-care systems. The condition was previously regarded as untreatable, but progress in understanding and management has resulted in earlier diagnosis and better treatment outcomes. A coherent syndrome of BPD typically onsets during adolescence (after age 12 years). BPD is often preceded by or co-develops with symptoms of internalising disorders (depression and anxiety), externalising disorders (conduct problems, hyperactivity, and substance use), or both. BPD is associated with various poor outcomes, including low occupational and educational attainment, lack of long-term relationships, increased partner conflict, sexual risk-taking, low levels of social support, low life satisfaction, and increased service use. Psychotherapy is the main treatment for BPD; drug treatment is only indicated for comorbid conditions that require medication, or during a crisis if psychosocial interventions are insufficient. Awareness of BPD by non-specialists, as well as specialists, is key to appropriate early intervention.
Importance
Borderline personality disorder (BPD) has been identified as a strong risk factor for suicidal behavior, including suicide attempts. Delineating specific features that increase risk could inform interventions.
Objective
To examine factors associated with prospectively observed suicide attempts among participants in the Collaborative Longitudinal Study of Personality Disorders (CLPS), over 10 years of follow-up, with a focus on BPD and BPD criteria.
Design, Setting, and Participants
The CLPS is a multisite, naturalistic, prospective study of adult participants with 4 personality disorders (PDs) and a comparison group of adults with major depressive disorder and minimal PD features. Participants were all treatment-seeking and recruited from inpatient, partial, and outpatient treatment settings across New York, New York, Boston, Massachusetts, New Haven, Connecticut, and Providence, Rhode Island. A total of 733 participants were recruited at baseline, with 701 completing at least 1 follow-up assessment. The cohorts were recruited from September 1996 through April 1998 and September 2001 through August 2002. Data for this study using this follow-up sample (N = 701) were analyzed between March 2019 and August 2020.
Main Outcomes and Measures
Participants were assessed annually using semistructured diagnostic interviews and a variety of self-report measures for up to 10 years. Multiple logistic regression analyses were used to examine baseline demographic and clinical risk factors, including BPD and individual BPD criteria, of suicide attempt assessed over 10 years of prospective follow-up.
Results
Of the 701 participants, 447 (64%) identified as female, 488 (70%) as White, 527 (75%) as single, 433 (62%) were unemployed, and 512 (73%) reported at least some college education. Of all disorders, BPD emerged as the most robust factor associated with prospectively observed suicide attempt(s) (odds ratio [OR], 4.18; 95% CI, 2.68-6.52), even after controlling for significant demographic (sex, employment, and education) and clinical (childhood sexual abuse, alcohol use disorder, substance use disorder, and posttraumatic stress disorder) factors. Among BPD criteria, identity disturbance (OR, 2.21; 95% CI, 1.37-3.56), chronic feelings of emptiness (OR, 1.63; 95% CI, 1.03-2.57), and frantic efforts to avoid abandonment (OR, 1.93; 95% CI, 1.17-3.16) emerged as significant independent factors associated with suicide attempt(s) over follow-up, when covarying for other significant factors and BPD criteria.
Conclusions and Relevance
In the multisite, longitudinal study of adults with personality disorders, identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment were significantly associated with suicide attempts. Identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment may be clinically overlooked features of BPD in context of suicide risk assessment. In light of the high rates of BPD diagnostic remission, our findings suggest that these criteria should be independently assessed and targeted for further study as suicide risk factors.
Research is scarce regarding the mechanisms by which pathological narcissism--consisting of narcissistic grandiosity and vulnerability--is linked with depression. The present study examined whether impaired emotional processing would mediate relations between pathological narcissism domains and depressive symptoms in a sample of 99 psychiatric outpatients. A significant indirect effect was found for narcissistic vulnerability on depressive symptoms, through unprocessed emotion as a mediator. Findings suggest that narcissistic vulnerability contributes to persistent and intrusive negative feelings, which in turn contribute to depressive symptom severity.
Herbert Rosenfeld makes a powerful case both for the intelligibility of psychotic symptoms and the potential benefits of their treatment by psychoanalytic means.
In this chapter, I present a theoretical framework that is aimed at explaining the complex and seemingly paradoxical structure, dynamics, and consequences of grandiose narcissism: the Narcissistic Admiration and Rivalry Concept (NARC). I first very briefly review the state of research on grandiose narcissism, showing that the content conceptually aligned with, and the measures typically applied to assess, grandiose narcissism can be sorted into more agentic and more antagonistic aspects that show unique nomological networks, dynamics, and outcomes. Then I describe a novel self-regulatory perspective, the NARC, which distinguishes between these agentic and antagonistic aspects of grandiose narcissism. According to the NARC, narcissists overarching goal to create and maintain a grandiose self can be pursued by two social strategies (narcissistic self-promotion and narcissistic self-defense) that translate into two sets of dynamics (narcissistic admiration and rivalry) with distinct affective-motivational, cognitive, and behavioral states that tend to have different social consequences (social potency and conflict). The NARC is meant to provide a clearer understanding of what grandiose narcissism is, how it works, and why it produces a rich variety of seemingly contradictory outcomes. I continue by presenting a summary of existing empirical evidence for the validity of the NARC, underlining its two-dimensional structure, the distinct mental and behavioral dynamics of narcissistic admiration and rivalry, and their unique intra- and interpersonal as well as institutional outcomes. Finally, I outline an agenda for future research that focuses on how admiration and rivalry combine, fluctuate, and develop within persons. © Springer International Publishing AG, part of Springer Nature 2018.
Background: This meta-analytic review is the first to synthesise findings from prospective research on the long-term course of borderline personality disorder in adult clinical populations.
Methods: Systematic searches were conducted in Medline, PsycINFO, PsycArticles, PubMed, and Scopus within the period 1990-2017. Inclusion criteria were: (1) adult BPD sample diagnosed by a validated, semi-structured interview; (2) at least two prospective assessments of outcomes; and (3) follow-up period >5 years. Quality of evidence was rated with the Systematic Assessment of Quality in Observational Research (SAQOR). Four outcomes were meta-analysed using mixed-effect methods: remission from BPD diagnosis, completed suicide, depressive symptoms, and functioning. Potential moderators regarding the natural course and the initial treatment received were studied.
Results: Eleven studies met the inclusion criteria, with 837 participants from nine countries being followed. Between 50% and 70% of the BPD patients achieved remission in the long-term. Significant reductions in depression and functional impairment were also found. Mean suicide rate ranged from 2% to 5%. Younger age was associated with higher likelihood for remission. Being female was correlated with lower functional improvement. Despite some positive trends, there were no significant associations between treatment moderators and the long-term outcome.
Conclusions: Findings suggest that the course of BPD is characterised by symptomatic amelioration and a slight functional improvement in the long-term. Age and gender modulate the long-term prognosis and should be considered to adapt treatment resources. Further research is required to draw robust conclusions on the long-term effects of psychotherapeutic interventions.
Several studies of the prevalence of Borderline Personality Disorder (BPD) in community and clinical settings have been carried out to date. Although results vary according to sampling method and assessment method, median point prevalence of BPD is roughly 1%, with higher or lower rates in certain community subpopulations. In clinical settings, BPD prevalence is around 10-12% in outpatient psychiatric clinics and 20-22% among inpatient clinics. Further research is needed to identify the prevalence and correlates of BPD in other clinical settings (e.g., primary care) and to investigate the impact of demographic variables on BPD prevalence.
Parental reflective functioning (PRF) is a robust predictor of parenting sensitivity and secure
infant attachment, but its assessment requires extensive resources, limiting its integration into research and clinical practice. The Mini-Parent Reflective Functioning Interview (Mini-PRFI) assesses the parent’s capacity to mentalize for his/her 6 month old infant (rated using the PRF coding system; Slade et al., 2004). In the current study we examined Mini-PRFI scores were associated with theoretically-related constructs; to establish a point of comparison, we evaluated links between Mini-PRFI scores alongside RF assessed from the Adult Attachment Interview (AAI). Mother–infant dyads (N = 88) completed the AAI before the birth of the infant, the Mini-PRFI and an interaction task (rated for insensitive) when infants were 6 months old, as well as the Strange Situation Procedure when infants were 16 months old. Mini-PRFI scores were strongly positively associated with AAI RF and negatively associated with maternal insensitivity. Mini-PRFI scores predicted infant attachment organization (secure/insecure, organized/disorganized) at 16 months, and this effect was mediated by parenting insensitivity.These findings suggest that the Mini-PRFI predicts theoretically-related attachment constructs,demonstrating the promise of the Mini-PRFI to increase the accessibility of interview-based PRF measurements to clinicians and researchers.
Keywords: reflective functioning, mentalization, attachment, sensitivity, disorganization
Abstract
Background: Childhood maltreatment is theorized to undermine the development of mentalizing and to disrupt the development of healthy narcissism and the integration of personality at the level of affect and interpersonal regulation. Consistent with this, mentalizing can be expected to mediate the relationship between childhood maltreatment and vulnerable and grandiose narcissism as well as borderline personality traits, but this has not been examined in adolescents.
Objective: The aim of this study was to examine associations between childhood maltreatment and adolescent personality disorder traits and test the mediating role of mentalizing in a sample of 263 adolescents and young adults aged 12 to 21.
Method: Participants recruited from school and a tertiary institution completed the Childhood Experiences of Care and Abuse Questionnaire (CECA-Q), the Borderline Personality Features Scale for Children (BPFS-C), the Pathological Narcissism Inventory (PNI) and the Reflective Function Questionnaire for Youth (RFQ-Y).
Results: Adolescents with histories of sexual and physical abuse reported significantly more borderline personality features, as well as vulnerable and grandiose narcissism. They also reported signficantly more mentalizing difficulties including confusion regarding mental states and excessive certainty regarding mental states of others. Confusion regarding mental states partially mediated the relation between emotional abuse and borderline personality traits, as well as vulnerable and grandiose narcissism. Excessive certainty regarding the mental states of others mediated the relationship between childhood experiences of role reversal and grandiose narcissism.
Conclusion: The findings are consistent with a mentalization model of adolescent personality difficulties and show that the relation between childhood maltreatment and personality disorder traits in adolescents may be in part understood in terms of the impact of such experiences on different dimensions of mentalizing.
Keywords: mentalizing, adolescents, maltreatment, Borderline Personality Disorder, Narcissistic Personality Disorder
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This article reviews historical contributions to the conceptualisation of narcissism and narcissistic personality disorder (NPD), including its evolution as a clinical diagnosis within the DSM classification of mental disorders. It discusses the epidemiology and aetiology of NPD, noting that empirical studies of both are limited. The challenges of managing patients with prominent narcissistic traits are presented, and the psychological therapies specifically designed for the treatment of patients with NPD are summarised.
LEARNING OBJECTIVES
• Understand different models of narcissism
• Understand the epidemiology, comorbidity and theories of aetiology of NPD
• Know how to manage and treat patients with pathological narcissism and NPD
DECLARATION OF INTEREST
None.
The goal of the present investigation was to expand the literature on impulsivity and Cluster B personality disorders (PDs) by conceptualizing impulsivity in a multidimensional manner. Two separate undergraduate samples (n = 223; n = 204) completed measures of impulsivity and Cluster B dimensions. Impulsivity was indeed predictive of Cluster B dimensions and, importantly, each PD scale exhibited a unique impulsivity profile. Findings for borderline PD scores were highly consistent across samples and strongly and positively associated with urgency and lack of perseverance, as expected. Findings for the other PD dimensions also exhibited a fair amount of consistency. Implications of these findings for diagnostic classification and treatment are discussed.
We investigated stability and change in personality disorder (PD) symptoms and whether depression severity, comorbid clinical psychiatric disorders, and social support predict changes in personality pathology among adolescent outpatients. The 1-year outcome of PD symptoms among consecutive adolescent psychiatric outpatients with depressive disorders (N = 189) was investigated with symptom count of depression, comorbid psychiatric disorders, and perceived social support as predictors. An overall decrease in PD symptoms in most PD categories was observed. Decreases in depression severity and in number of comorbid diagnoses correlated positively with decreases in PD symptoms of most PD categories. Social support from close friends predicted a decrease in schizotypal and narcissistic, whereas support from family predicted a decrease in paranoid symptoms. Our results suggest that among depressed adolescent outpatients, PD symptoms are relatively unstable, changes co-occuring with changes/improvement in overall psychopathology. Social support seems a possibly effective point for intervention efforts regarding positive outcome of PD symptoms.
The present neuroimaging study investigated two aspects of difficulties with emotion associated with Borderline Personality Disorder (BPD): affective lability and difficulty regulating emotion. While these two characteristics have been previously linked to BPD symptomology, it remains unknown whether individual differences in affective lability and emotion regulation difficulties are subserved by distinct neural substrates within a BPD sample. To address this issue, sixty women diagnosed with BPD were scanned while completing a task that assessed baseline emotional reactivity as well as top-down emotion regulation. More affective instability, as measured by the Affective Lability Scale (ALS), positively correlated with greater amygdala responses on trials assessing emotional reactivity. Greater difficulties with regulating emotion, as measured by the Difficulties with Emotion Regulation Scale (DERS), was negatively correlated with left Inferior Frontal Gyrus (IFG) recruitment on trials assessing regulatory ability. These findings suggest that, within a sample of individuals with BPD, greater bottom-up amygdala activity is associated with heightened affective lability. By contrast, difficulties with emotion regulation are related to reduced IFG recruitment during emotion regulation. These results point to distinct neural mechanisms for different aspects of BPD symptomology.
This chapter reviews the theoretical and empirical literatures that link parenting behavior to child narcissism and makes methodological recommendations for future work on that link. The review finds support for both the social learning and psychodynamic perspectives on narcissistic origins and emphasizes the importance of distinguishing between grandiose and vulnerable forms when investigating the causes of narcissism.
This study examined narcissistic vulnerability and shame-proneness as potential mediators between childhood physical abuse (CPA) and adult anger and aggression. Participants were 400 undergraduate students, 134 of whom had a history of CPA. All participants completed self-report questionnaires assessing history of CPA, shame-proneness, narcissistic vulnerability, physical aggression, trait anger, and hostility. Results indicated abused participants were more angry and aggressive and experienced higher levels of shame-proneness and narcissistic vulnerability than nonabused participants. Multiple mediation analyses showed that narcissistic vulnerability, but not shame-proneness, partially mediated the relation between abuse and physical aggression. However, narcissistic vulnerability and shame-proneness both emerged as partial mediators between abuse and the anger and hostility variables. These findings suggest that narcissistic vulnerability and shame-proneness may function as mediators of adjustment following childhood maltreatment. Study limitations and recommendations for future research are discussed.
This study examined a broad variety of adverse childhood experiences in a consecutive sample of female adolescent inpatients with borderline personality disorder (BPD; n = 44) compared with a clinical control (CC; n = 47) group with mixed psychiatric diagnoses. BPD was diagnosed using a structured clinical interview; different dimensions of childhood adversity were assessed using the Childhood Experiences of Care and Abuse Questionnaire, the Parental Bonding Instrument, and the Family Assessment Device. A history of childhood adversity was significantly more common in patients with BPD than in the CC group. Using a multivariate model, sexual abuse (OR = 13.8), general family functioning (OR = 8.9), and low maternal care (OR = 7.6) were specific and independent predictors of adolescent BPD. The results increase our knowledge of the specific role of different dimensions of childhood adversity in adolescent BPD. They have important implications for prevention and early intervention as they highlight the need for specific strategies for involving the family.
The authors use a new diagnostic algorithm derived from the Diagnostic Interview Schedule (the DIS/Borderline Index) to identify a borderline personality disorder among 19- to 55-year-olds at the Duke site of the Epidemiologic Catchment Area project. A criterion score of 11 or more symptoms from the 24-item DIS/Borderline Index identifies 1.8% of the sample. The borderline diagnosis is significantly higher among females, the widowed, and the unmarried; and there is a trend toward the diagnosis in younger, non-White, urban, and poorer respondents. Extensive psychiatric comorbidity and high use of mental health services are found in the borderline group.
The frequency of DSM-III, Axis II personality disorders and their relationship to selected demographic and clinical characteristics were investigated in a sample of 249 outpatients with major depressive disorder. Thirty-five percent of the sample had at least one personality disorder using stringent criteria; an additional 40% had a probable personality disorder. The most frequent disorders were in the “anxious' cluster of Axis II, including avoidant, dependent, and obsessive-compulsive. Paranoid, histrionic, and borderline were the next most common disorders. Personality disorder patients had more prior episodes of depression and were more likely to be diagnosed as recurrent MDD. They also had a longer duration of current episode, were more likely to have a diagnosis of endogenous depression, and had higher ratings of distress on multiple dimensions of general symptomatology. In addition, patients in the Axis II “odd” and “dramatic” clusters were less likely to be married, and dramatic patients were youn...
Personality disorders are common and ubiquitous in all medical settings, so every medical practitioner will encounter them frequently. People with personality disorder have problems in interpersonal relationships but often attribute them wrongly to others. No clear threshold exists between types and degrees of personality dysfunction and its pathology is best classified by a single dimension, ranging from normal personality at one extreme through to severe personality disorder at the other. The description of personality disorders has been complicated over the years by undue adherence to overlapping and unvalidated categories that represent specific characteristics rather than the core components of personality disorder. Many people with personality disorder remain undetected in clinical practice and might be given treatments that are ineffective or harmful as a result. Comorbidity with other mental disorders is common, and the presence of personality disorder often has a negative effect on course and treatment outcome. Personality disorder is also associated with premature mortality and suicide, and needs to be identified more often in clinical practice than it is at present.
Copyright © 2015 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Published by Elsevier Ltd. All rights reserved.