Diagnosis, Classification, and Assessment of Narcissistic Personality Disorder Within the Framework of Object Relations Theory

Caligor, Eve; Stern, Barry L.

doi:10.1521/pedi.2020.34.supp.104

Cited by 17 publications

(23 citation statements)

References 16 publications

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“…The difficulty for these patients is the pain and distress that accompanies having such disparate 'split off' or unintegrated parts of the self, which result in the defensive use of maladaptive intra and interpersonal methods of maintaining a stable self-experience [24]. This defensive operation is somewhat successful, and may give the impression of a coherent and stable identity, however as noted by Caligor and Stern [25] "manifestly vulnerable narcissists retain a connection to their grandiosity … [and] even the most grandiose narcissist may have internal feelings of inadequacy or fraudulence" (p. 113).…”

Section: Introductionmentioning

confidence: 99%

Living with pathological narcissism: a qualitative study

Day

Townsend

Grenyer

2020

bord personal disord emot dysregul

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Background: Research into the personality trait of narcissism have advanced further understanding of the pathological concomitants of grandiosity, vulnerability and interpersonal antagonism. Recent research has established some of the interpersonal impacts on others from being in a close relationship with someone having such traits of pathological narcissism, but no qualitative studies exist. Individuals with pathological narcissism express many of their difficulties of identity and emotion regulation within the context of significant interpersonal relationships thus studying these impacts on others is warranted. Method: We asked the relatives of people high in narcissistic traits (indexed by scoring above a cutoff on a narcissism screening measure) to describe their relationships (N = 436; current romantic partners [56.2%]; former romantic partners [19.7%]; family members [21.3%]). Participants were asked to describe their relative and their interactions with them. Verbatim responses were thematically analysed. Results: Participants described 'grandiosity' in their relative: requiring admiration, showing arrogance, entitlement, envy, exploitativeness, grandiose fantasy, lack empathy, self-importance and interpersonal charm. Participants also described 'vulnerability' of the relative: contingent self-esteem, hypersensitivity and insecurity, affective instability, emptiness, rage, devaluation, hiding the self and victimhood. These grandiose and vulnerable characteristics were commonly reported together (69% of respondents). Participants also described perfectionistic (anankastic), vengeful (antisocial) and suspicious (paranoid) features. Instances of relatives childhood trauma, excessive religiosity and substance abuse were also described. Conclusions: These findings lend support to the importance of assessing the whole dimension of the narcissistic personality, as well as associated personality patterns. On the findings reported here, the vulnerable aspect of pathological narcissism impacts others in an insidious way given the core deficits of feelings of emptiness and affective instability. These findings have clinical implications for diagnosis and treatment in that the initial spectrum of complaints may be misdiagnosed unless the complete picture is understood. Living with a person with pathological narcissism can be marked by experiencing a person who shows large fluctuations in affect, oscillating attitudes and contradictory needs.

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Section: Introductionmentioning

confidence: 99%

Living with pathological narcissism: a qualitative study

Day

Townsend

Grenyer

2020

bord personal disord emot dysregul

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“…The AMPD comes close to how psychoanalytic therapists could conceptualize their daily practice (see also : Caligor and Stern, 2020). As mentioned here, a positive aspect of the AMPD is that the diagnostic evaluation of the level of personality functioning is based on a structured clinical evaluation of four clinically relevant elements.…”

Section: Discussionmentioning

confidence: 83%

“…Kernberg's structural model for personality organization could provide an insight into the severity of all these thematic elements, in other words whether relevant psychodynamic features are organized in a neurotic or highlevel/low-level borderline way. This provides the practitioner with information about the prognosis and the indication for the treatment model (Caligor and Stern, 2020).…”

Section: Discussionmentioning

confidence: 99%

Narcissistic Personality Disorder: Are Psychodynamic Theories and the Alternative DSM-5 Model for Personality Disorders Finally Going to Meet?

et al. 2021

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Narcissistic Personality Disorder is the new borderline personality disorder of our current era. There have been recent developments on narcissism that are certainly worthwhile examining. Firstly, relational and intersubjective psychoanalysts have been rethinking the underlying concepts of narcissism, focusing on the development of self and relations to others. Secondly, in the DSM-5, the Alternative DSM-5 Model for Personality Disorders (AMPD) was presented for a dimensional evaluation of the severity of personality disorder pathology. The combined dimensional and trait conceptualization of NPD opened the door to new integrated diagnostic perspectives, including both internal and interpersonal functioning. Finally, Pincus and Lukowitsky encourage clinicians to use a hierarchical model of pathological narcissism, as it opens up opportunities for shared points of interest in empirical research from different scholarly perspectives. As for most non-psychodynamic clinicians and researchers the DSM-5 clearly bears dominant weight in their work, we will take the AMPD model for NPD as our point of reference. We will discuss the narcissist's unique pattern of self-impairments in identity and self-direction, and of interpersonal disfunctioning (evaluated by assessing empathy and intimacy). Subsequently, we will examine how contemporary psychodynamic theories and the hierarchical model of Pincus and Lukowitsky additionally inform or contradict the AMPD. For us, one of the big advantages of the AMPD is the use of structured clinical evaluations of disturbances of the self and interpersonal functioning and the dimensional evaluation of severity. As psychodynamically oriented therapists, we are enthusiastic about the opportunities for inclusion of psychodynamic concepts, but we also discuss a number of sticking points.

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“…For reasons of argumentative simplicity, we will only consider the nosographic model here, distinguishing borderline personality disorder from the following disorders [5,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37].…”

Section: Etiological Profi Lementioning

confidence: 99%

“…"Narcissistic personality disorder": Both are very sensitive to criticism, but the narcissist, however, has a fi xed sense of his superiority (grandiose self) that the borderline does not have stably [29,30].…”

Section: Etiological Profi Lementioning

confidence: 99%

Borderline personality disorder: Definition, differential diagnosis, clinical contexts, and therapeutic approaches

Perrotta¹

2020

Ann Psychiatry Treatm

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Defi nition, differential diagnosis and clinical context of borderline personality disorder Defi nition, introduction and epidemiological profi le:The term "borderline" was born as a label aimed at describing a whole series of characteristics and behaviors that are diffi cult to defi ne. Migone (1990) draws up a list of the defi nitions of different authors, which refer more or less directly to the borderline area, below some: "borderline neurosis" (Clark, 1919), "parataxies in certain borderline mental states" (Moore, 1921), "impulsive character", "incipient schizophrenia"

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Diagnosis, Classification, and Assessment of Narcissistic Personality Disorder Within the Framework of Object Relations Theory

Cited by 17 publications

References 16 publications

Living with pathological narcissism: a qualitative study

Living with pathological narcissism: a qualitative study

Narcissistic Personality Disorder: Are Psychodynamic Theories and the Alternative DSM-5 Model for Personality Disorders Finally Going to Meet?

Borderline personality disorder: Definition, differential diagnosis, clinical contexts, and therapeutic approaches

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