Narcissistic Personality Disorder Patients Research Articles

The ongoing rewriting of the therapeutic contract in Metacognitive Interpersonal Therapy for narcissistic personality disorder: The case of Mark.

In order to effectively treat individuals suffering from Narcissistic Personality Disorder (NPD), it is crucial to establish therapeutic goals and identify tasks to achieve them. However, this is a challenging process with NPD patients because they often struggle to find meaningful goals beyond the pursuit of status. Moreover, in order to change Furthermore, to promote change, they must confront painful emotions such as shame, guilt, or fear, which they habitually try to avoid. Additionally, they face difficulties in forming a positive perception of their therapists and cooperating towards mutually agreed-upon goals and tasks. As a consequence, NPD patients ask for change but hardly engage themselves in the work necessary to achieve it. Therapists therefore need to pay the uttermost attention to drafting, negotiating and continuously updating a reasonable and realistic therapeutic contract. In this paper we describe the story of a man in his thirties with NPD who was ridden with depression, guilt, envy and anger and did not find ways to pursue the healthy and adaptive behaviors he would need to pursue in order to leave a richer social life. The therapist overcame ruptures in the therapeutic alliance and then involved the patient in a process where they set the steps to follow, making sure the patient was convinced they made sense. After a contract was reached progress became possible. Implications for the role of the therapeutic contract in NPD treatment are discussed.

Maladaptive daydreaming and narcissism

Maladaptive daydreaming (MD) refers to excessive absorption in fantasy worlds, sometimes for many hours a day, which interferes with academic, occupational and social functioning. It shares features of a behavioural addiction which may negatively impact psychotherapy of patients with personality disorders. Links were found between MD and vulnerable narcissism (VN) but no studies have compared MD and specific types of narcissism in clinical groups, especially narcissistic personality disorder (NPD). This study explored MD, narcissistic rivalry, admiration, and VN in 491 participants classified into three groups: NPD, mixed-clinical and non-clinical. It also examined whether rivalry, admiration and VN predicts MD. The level of MD was significantly higher in the NPD group compared with mixed-clinical and non-clinical groups. Over 2/3 of NPD patients had scores indicating MD compared to ⅓ from the mixed-clinical and less than 1/4 from non-clinical groups. VN was the strongest predictor of MD. Results justify the need for screening NPD patients, especially those with vulnerable traits, for MD and actively addressing this problem during treatment.

Level of identity diffusion in patients with borderline, narcissistic, avoidant and other specified personality disorder

Traditional conceptions of personality disorder (PD) view severe identity disturbance as a defining characteristic of borderline personality disorder (BPD). In the alternative DSM-5 model for PDs (AMPD) and in the outlined substantial changes to PD diagnostics in ICD-11, disturbances in self and identity are elevated from a specific diagnostic criterion for BPD to a defining criterion for PD in general. In line with Kernberg’s theory of personality organization (PO), it is expected that although identity disturbance may be characteristic of most or all PDs, severe identity diffusion is a more pronounced and defining characteristic of BPD and possibly other PDs organized on a borderline level (BPO). Here, we examined the level of identity disturbance in SCID-diagnosed patients with BPD, narcissistic PD (NPD), avoidant PD (AVPD), comorbid BPD with NPD and AVDP, as well as other specified PD (PD-OT). We found that measures of identity diffusion were higher in BPD and NPD patients compared with patients diagnosed with AVPD. Hierarchical multiple regression analyses showed that number of SCID criteria met for BPD and NPD predicted level of identity diffusion when gender, age and general symptomatology were controlled for, whereas number of SCID criteria met for AVPD did not. The presented data support severe identity diffusion as a prominent characteristic of BPD with possible implications for how we should differentiate BPD from other PDs. The findings are discussed in relation to Kernberg’s model and the AMPD.

Influence of Cultural and Contextual Factors on the Presentation, Risk Factors, and Treatment of Narcissistic Personality Disorder

Background: In spite of personality disorder is a common topic in the field of psychology and psychiatry, there are still very few studies few studies focusing on cultural and contextual factors of Narcissistic personality disorder (NPD).Method: By reviewing the literature about three countries UK, US and China, the precent study sort out the sociocultural and contextual differences of prevalence, presentation, risk factors and treatment of Narcissistic Personality Disorder (NPD).Result: Contextual and cultural factors have great impact on wide range of NPD’s different aspects. For the prevalence rate of three countries, comparing the highest percentage of three data, UK’s NPD prevalence rate is greater than US, and China has the less NPD prevalence rate. Concerning the presentation of NPD, female and male patients present variously. There is no data responding three countries’ patients’ NPD presentation. With regard of different risk factors, biology, psychotherapy and sociocultural are three of the most essential ones. Eventually, the NPD treatments of three different countries shows significant variety, including Chinese treatments related to traditional medicine, British mentalisation-based treatment and most widely used treatment in America--dialectical behavior therapy.

Toward Developing Clinical cut-off for the Grandiosity Scale of the Dimensional Clinical Personality Inventory 2

ObjectiveThe present study aims to establish a clinical cut-off for the Grandiosity dimension, using item-level evaluation procedures. MethodsParticipants were 5,387 adults, including outpatients diagnosed with narcissistic personality disorder (NPD), outpatients diagnosed with other personality disorders, and adults from the community. We administered the self-reported Grandiosity scale from the Dimensional Clinical Personality Inventory 2 (IDCP-2). The equating procedure was applied to generate theta scores for participants who did not answer all items. ResultsThe Wright map revealed that outpatients scored high on the latent continuum of the Grandiosity scale. Group comparison showed large effect sizes for the mean difference between patients and non-patients. The ROC curve supports a cut off at a –0.45 score in theta standardisation, which yields a high sensitivity (91%) and moderate specificity (58%). Moreover, the PPP (71%) and NPP (79%) values suggest that the scale is able to identify NPD patients in 71% of cases, and people without NPD in 79% of cases. ConclusionsThe findings suggest the IDCP-2 Grandiosity scale is useful as an NPD screening tool. Possible clinical applications for the scale are described and the limitations of the study are discussed.

EEG Features in Adolescent Patients with Borderline and Narcissistic Personality Disorder

IntroductionPersonality disorders (PD) in adolescence are widespread. It creates problems of social adaptation of patients and represents significant risk factors for auto-aggressive behavior, including suicidal one. The neurobiological basis and EEG markers of PD in adolescence have not been adequately studied.ObjectivesThe aim of the study was to reveal the EEG features and their correlations with clinical parameters in male adolescents with borderline personality disorder (BPD) and narcissistic personality disorder (NPD), possibly mediating some aspects of their clinical traits.Methods28 BPD patients (301.83, by DSM-5) and 24 NPD patients (301.81, by DSM-5), as well as 24 healthy controls (HC) aged 16-25 years were enrolled in the study. HDRS-21 and HAM-A scales were used for quantitative assessment of patient’s conditions. Pre-treatment resting EEG was recorded, and EEG spectral analysis was carried out in 8 narrow frequency sub-bands. Descriptive statistics and correlation analysis of EEG and clinical data were performed.ResultsEEG spectral parameters in BPD group did not differ significantly from those of HC. NPD group shows the EEG signs of more activated brain cortex than in both BPD and norm groups caused by decreased functional state of the anterior cortical regions. The structure of correlations between EEG parameters and clinical scores also differed between BPD and NPD groups.ConclusionsThe data obtained suggests that these features of the brain activity may contribute to the disturbance of emotion regulation and of behavior control in adolescent patients with BPD and NPD, more pronounced in NPD group.DisclosureNo significant relationships.

542 - Development and validation of the narcissistic personality screening questionnaire (NPSQ) among Thai older adults

BackgroundA screening tool for narcissistic personality disorder (NPD) in older adults is lacking.ObjectiveThe study aimed to develop a screening tool for detecting symptoms of the NPD and to validate its psychometric properties in older adults.MethodsThis Narcissistic Personality Screening Questionnaire (NPSQ) was developed by constructing items based on DSM-5 criteria of the narcissistic personality disorder (NPD). A literature review regarding the signs and symptoms of NPD was conducted. Interview with NPD patients, the patients’ key informants, and a focus group discussion among psychiatrists, psychiatric nurses and psychiatry residents who have experience in working with patients with NPD were performed. After the items were created, the content validity index (CVI) by 1 psychologist and 1 psychiatrist was analyzed. A field trial was conducted among older adult patients visiting the psychiatry and the cardiology departments at Maharaj Nakorn Chiang Mai hospital between March and April 2021. The internal consistency using Cronbach alpha was analyzed.Item hierarchy, item difficulty, and item fit was also calculated usingRasch analysis. Qualitative information was analyzed regarding language use and time to complete the test.ResultsOriginally, a total of 80 NPSQ items with 4-Likert scales i.e., strongly agree, moderately agree, slightly agree, and disagree were generated. The CVI was 0.75-1 for item-CVI and 0.89 for scale-CVI. The NPSQ was examined among 30 Thai older adults with a mean age of 70.76 ± 6.23 years. The percent of missing items of all 80 items ranged from 2.9% to 8.9%. Cronbach’s alpha for the 80-item NPSQ wasTo determine the correlation of hippocampal volume with Mini-Mental State Examination 0.96. Rasch analysis identified 37 misfitting with a mean square > 1.50, therefore 43 items remained. Person-item map showed a good target between items and sample, even though some items may be redundant. Cronbach’s alpha for the 43-item NPSQ was 0.96. Some participants were confused about who the questions referred to, which were then revised before including it in the final draft version. Only one participant did not complete the questionnaire.ConclusionThe 43 item NPSQ shows good content validity and an excellent internal consistency among older adults. A study with a larger sample size is warranted.

Mental health clinicians' attitudes toward narcissistic personality disorder.

Narcissistic personality disorder (NPD) is an underdiagnosed psychiatric condition in which there is minimal research to support a validated treatment regimen. As a result, it is unclear how mental health practitioners approach NPD patients and the outcomes of clinical management. Given this gap in current mental health practice, this article explores the attitudes of clinicians toward treating NPD patients and the clinician-reported outcomes of managing NPD patients. The study uses a qualitative and quantitative approach to analyze the results of a 16-question survey about clinicians' experiences working with NPD patients. 173 participants were recruited from online psychology interest forums between April 2019 to August 2019. The data were analyzed using the Statistical Package for the Social Scientist (SPSS-26). The qualitative data showed that clinicians find NPD patients to be difficult and challenging. Additionally, clinicians report minimal experience treating NPD and high treatment drop-out rates. The quantitative data were evaluated using Pearson correlation coefficients. These results show that clinicians who view NPD as a diagnosis worth treating report more benefit from their care. These results also showed that participants who report formal didactic training in NPD have better results with their patients. The data also show that clinicians feel group therapy can be helpful in treating NPD, despite reporting that it is often not offered to NPD patients. This is an area that can direct future NPD research to develop a comprehensive approach to NPD management. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Toward Developing Clinical cut-off for the Grandiosity Scale of the Dimensional Clinical Personality Inventory 2

ObjectiveThe present study aims to establish a clinical cut-off for the Grandiosity dimension, using item-level evaluation procedures. MethodsParticipants were 5,387 adults, including outpatients diagnosed with narcissistic personality disorder (NPD), outpatients diagnosed with other personality disorders, and adults from the community. We administered the self-reported Grandiosity scale from the Dimensional Clinical Personality Inventory 2 (IDCP-2). The equating procedure was applied to generate theta scores for participants who did not answer all items. ResultsThe Wright map revealed that outpatients scored high on the latent continuum of the Grandiosity scale. Group comparison showed large effect sizes for the mean difference between patients and non-patients. The ROC curve supports a cut off at a –0.45 score in theta standardisation, which yields a high sensitivity (91%) and moderate specificity (58%). Moreover, the PPP (71%) and NPP (79%) values suggest that the scale is able to identify NPD patients in 71% of cases, and people without NPD in 79% of cases. ConclusionsThe findings suggest the IDCP-2 Grandiosity scale is useful as an NPD screening tool. Possible clinical applications for the scale are described and the limitations of the study are discussed.

Dos and Don'ts in Treatments of Patients With Narcissistic Personality Disorder.

This article identifies guiding principles in effective psychotherapies of patients with narcissistic personality disorder (NPD) and cautions against some common pitfalls. Individual psychotherapies of NPD patients were examined by both authors, who tested whether or not some principles, recommended in the literature, effectively promote these therapies and help these patients in moving forward with their lives and with effective therapy use. The authors identify a number of principles that were associated with more positive therapy development: helping patients identify goals and direction of their therapies, promoting a sense of agency, promoting a shift of focus to sense of vulnerability, and anticipating difficulty in developing and maintaining the treatment alliance. Common mistakes in these treatments are engaging in a power struggle with the patient, overindulging the grandiosity of the patient, directly challenging the grandiosity of the patient, and ignoring treatment-interfering behaviors. Identification of principles of effective therapies with NPD patients can help with the development of more effective treatment approaches for NPD.

Symptom severity and mindreading in narcissistic personality disorder.

BackgroundGrandiose narcissism has been associated with poor ability to understand one’s own mental states and the mental states of others. In particular, two manifestations of Narcissistic Personality Disorder (NPD) can be explained by poor mindreading abilities: absence of symptomatic subjective distress and lack of empathy.MethodsWe conducted two studies to investigate the relationships between mindreading capacity, symptomatic subjective distress and narcissistic personality. In the first study (N = 246), we compared mindreading capacities and symptomatic distress in three outpatient samples: narcissistic patients (NPD); patients with other Personality Disorders (PD); patients without PD. In the second study (N = 1357), we explored the relationships between symptomatic distress, mindreading and specific NPD criteria.ResultsIn the first study, the NPD patients showed poorer mindreading than the patients without PD and comparable to patients with other PDs. Symptomatic subjective distress in the narcissistic group was less severe than in the other PDs group and comparable to the group without PDs. However, no relationship emerged between mindreading and symptomatic subjective distress. In the second study, taking the clinical sample as a whole, symptomatic distress appeared negatively linked to grandiosity traits, while mindreading scores were negatively linked to empathy.ConclusionsNPD showed specific mindreading impairments. However, mindreading capacity did not appear to be directly connected with subjective distress, but did appear to be connected with specific aspects of narcissistic pathology.

Countertransference when working with narcissistic personality disorder: An empirical investigation.

Narcissistic personality disorder (NPD) is one of the most challenging clinical syndromes to treat in psychotherapy, especially due to the difficulties of establishing a good enough therapist-patient relationship. Countertransference responses to NPD can be particularly intense, frustrating, and difficult to manage, as is often reported in the clinical literature though not clearly supported empirically. The aims of this study were to (a) investigate the relationship between patients' NPD and therapists' responses; (b) examine the associations between patient, clinician, therapy variables and clinicians' reactions during treatment of NPD patients; and (c) provide an empirically derived portrait of countertransference with NPD. A sample of psychiatrists and clinical psychologists (N = 67) completed the Therapist Response Questionnaire to identify patterns of countertransference, the Shedler-Westen Assessment Procedure-200, and the Global Assessment of Functioning Scale to assess the personality pathology and psychosocial functioning of a patient in their care. The results showed that NPD was positively associated with hostile/angry, criticized/devalued, helpless/inadequate, and disengaged countertransference and negatively associated with therapists' positive response, regardless of patients' personality and psychosocial functioning. NPD patients with stronger traits of cluster B personality pathology tended to elicit more negative and heterogeneous countertransference reactions than NPD patients without these features. The countertransference patterns with NPD patients were not strongly influenced by the variables of clinicians and therapy, with the exception of clinical experience. Overall, the portrait of therapists' reactions to NPD provided a clinically nuanced and empirically founded description strongly resembling theoretical-clinical accounts. The therapeutic implications of these findings were discussed. (PsycINFO Database Record

Narcissistic Personality Disorder and suicidal behavior in mood disorders

The relationship of Narcissistic Personality Disorder (NPD) to suicidal behavior is understudied. The modest body of existing research suggests that NPD is protective against low-lethality suicide attempts, but is associated with high lethality attempts. Mood-disordered patients (N = 657) received structured interviews including Axis I and II diagnosis and standardized clinical measures. Following chi-square and t-tests, a logistical regression model was constructed to identify predictors of suicide attempt. While there was no bivariate relationship of NPD on suicide attempt, in the logistic regression patients with NPD were 2.4 times less likely to make a suicide attempt (OR = 0.41; 95% CI = 0.19 - 0.88; p < 0.05), compared with non-NPD patients and controlling for possible confounding variables. NPD was not associated with attempt lethality. NPD patients were more likely to be male, to have a substance use disorder, and to have high aggression and hostility scores. Limitations include that the sample consists of only mood-disordered patients, a modest sample size of NPD, and the data are cross-sectional. The multivariate protective effect of NPD on suicide attempt is consistent with most previous research. The lower impulsivity of NPD patients and less severe personality pathology relative to other personality disorders may contribute to this effect. No relationship of NPD to attempt lethality was found, contradicting other research, but perhaps reflecting differences between study samples. Future studies should oversample NPD patients and include suicide death as an outcome. Clinical implications include discussion of individualized suicide risk assessment with NPD patients.

A masked negative self-esteem? Implicit and explicit self-esteem in patients with Narcissistic Personality Disorder

The mask model of narcissism states that the narcissistic traits of patients with NPD are the result of a compensatory reaction to underlying ego fragility. This model assumes that high explicit self-esteem masks low implicit self-esteem. However, research on narcissism has predominantly focused on non-clinical participants and data derived from patients diagnosed with Narcissistic Personality Disorder (NPD) remain scarce. Therefore, the goal of the present study was to test the mask model hypothesis of narcissism among patients with NPD. Male patients with NPD were compared to patients with other PD's and healthy participants on implicit and explicit self-esteem. NPD patients did not differ in levels of explicit and implicit self-esteem compared to both the psychiatric and the healthy control group. Overall, the current study found no evidence in support of the mask model of narcissism among a clinical group. This implicates that it might not be relevant for clinicians to focus treatment of NPD on an underlying negative self-esteem.

Réflexions sur le traitement basé sur la mentalisation ainsi que son adaptation pour des hommes présentant des troubles de la personnalité mixte ou narcissique

Narcissistic personality disorder (NPD) and not otherwise specified personality disorder (borderline and narcissistic) are major mental health problems for men. These pathologies predispose patients to significant relational difficulties which are characterised by intense reactions to perceived threats to the self-esteem and an impaired empathic ability. Understanding these disorders as affect dysregulation stimulated by shame, the author presents how patients in this context are prone to lose their capacity to mentalize. This article describes a specific individual and group mentalization-based treatment and its implementation for treating narcissistic men. Different reflections on the treatment, on empathy, as well as on the adaptation of this treatment for NPD patients are presented and illustrated with clinical vignettes.

Gray matter abnormalities in patients with narcissistic personality disorder

BackgroundDespite the relevance of narcissistic personality disorder (NPD) in clinical settings, there is currently no empirical data available regarding the neurobiological correlates of NPD. In the present study, we performed a voxel-based morphometric analysis to provide initial insight into local abnormalities of gray matter (GM) volume. MethodsStructural brain images were obtained from patients with NPD (n = 17) and a sample of healthy controls (n = 17) matched regarding age, gender, handedness, and intelligence. Groups were compared with regard to global brain tissue volumes and local abnormalities of GM volume. Regions-of-interest analyses were calculated for the anterior insula. ResultsRelative to the control group, NPD patients had smaller GM volume in the left anterior insula. Independent of group, GM volume in the left anterior insula was positively related to self-reported emotional empathy. Complementary whole-brain analyses yielded smaller GM volume in fronto-paralimbic brain regions comprising the rostral and median cingulate cortex as well as dorsolateral and medial parts of the prefrontal cortex. ConclusionHere we provide the first empirical evidence for structural abnormalities in fronto-paralimbic brain regions of patients with NPD. The results are discussed in the context of NPD patients' restricted ability for emotional empathy.

The Narcissistic Personality Inventory: A Useful Tool for Assessing Pathological Narcissism? Evidence From Patients With Narcissistic Personality Disorder

The Narcissistic Personality Inventory (NPI) has dominated research on narcissism in the field of social and personality psychology. Surprisingly, it is unclear whether the NPI is useful for identifying pathological narcissism in patients with Narcissistic Personality Disorder (NPD). The goal of this study was to close this research gap. We used an extreme-group approach by including NPD patients and healthy controls and comparing their narcissism scores. We further investigated whether explicit self-esteem (assessed with the Rosenberg Self-Esteem Scale) suppressed the relationship between group membership and NPI narcissism. According to our results, NPD patients do not score higher on the NPI in comparison to healthy controls. Analysis of indirect effects revealed that differences in NPI scores are suppressed by NPD patients’ low self-esteem. Our results indicate that the NPI is not a valid indicator of NPD, unless one controls for self-esteem. Implications for future research are discussed.

Subtypes, Dimensions, Levels, and Mental States in Narcissism and Narcissistic Personality Disorder

Various conceptualizations of subtypes, levels, and dimensions of narcissism and narcissistic personality disorder (NPD) are considered with a particular focus on overt grandiose presentations and covert vulnerable presentations. Evidence supporting this distinction and clinical vignettes to illustrate it are presented as well as their implications for clinical work with NPD patients. The research and clinical evidence points to the conclusion that these broad categorical subtypes are better conceptualized as dimensions on which individual patients vary on relative levels, thus suggesting that grandiose and vulnerable presentations represent two sides of the same coin. A case example and clinical implications are provided and discussed.

Disturbed emotion recognition in patients with narcissistic personality disorder

Although theoretically the lack of empathy is a supposed key symptom of narcissistic personality disorder (NPD), empirical studies examining empathy in NPD are scarce. In the present study it was examined whether patients with NPD differ from healthy controls and a psychiatric control group in their empathic abilities. In order to examine this question, 20 patients with NPD, 20 patients with a personality disorder in the Cluster C spectrum and 20 healthy control participants were presented with a questionnaire and a facial recognition task designed to measure empathic abilities. It was found that patients with NPD did not differ from the two control groups on a self-report questionnaire indicating that patients regard themselves as sensitive to the feelings of others. On the contrary, it was found NPD patients generally performed worse on a facial emotion recognition task compared to both control groups. In addition to this general deficit in emotion recognition, patients with NPD showed a specific deficit for emotions representing fear and disgust. These results provide the first empirical evidence for impaired emotion recognition in patients with NPD.

Lack of empathy in patients with narcissistic personality disorder

The study's objective was to empirically assess cognitive and emotional empathy in patients with narcissistic personality disorder (NPD). To date, “lack of empathy” is a core feature of NPD solely based on clinical observation. The study's method was that forty-seven patients with NPD, 53 healthy controls, and 27 clinical controls with borderline personality disorder (BPD) were included in the study. Emotional and cognitive empathy were assessed with traditional questionnaire measures, the newly developed Multifaceted Empathy Test (MET), and the Movie for the Assessment of Social Cognition (MASC). The study's results were that individuals with NPD displayed significant impairments in emotional empathy on the MET. Furthermore, relative to BPD patients and healthy controls, NPD patients did not show deficits in cognitive empathy on the MET or MASC. Crucially, this empathic profile of NPD is not captured by the Structured Clinical Interview for DSM-IV for Axis II Disorders (SCID-II). The study's conclusions were that while NPD involves deficits in emotional empathy, cognitive empathy seems grossly unaffected.