Narcissistic Vulnerabilities Research Articles

Management of Suicidality with Borderline and Narcissistic Features

General suicide risk assessment and management should include consideration of core borderline and narcissistic vulnerabilities of interpersonal hypersensitivity and self-esteem dysregulation. Understanding the oscillating phenomenology of these vulnerabilities using the basic personality disorder treatment approach of Good Psychiatric Management provides a coherent, practical method for assessing and managing suicide risk not only in patients with these personality disorders but more broadly in those with some traits of personality disorder but not meeting full diagnostic criteria. [ Psychiatr Ann . 2020;50(4):139–145.]

La radicalisation, un nouveau symptôme adolescent ?

BackgroundFor over two years, in Strasbourg (France) the teams of the University Department for Children and Adolescent Psychiatry and from the “Maison des adolescents” have been facing the issue of radicalization in their daily work. The aim of this paper is to specify the psychological vulnerabilities and the psychopathological mechanisms underlying indoctrination processes in today's teenagers. MethodsWe used clinical observations of about twenty-five long-term follow-ups of adolescents who were already radicalized or supposedly at risk of radicalization. All underwent individual or familial therapy with child and adolescent psychiatrists between December 2014 and November 2016 in Strasbourg, either at the University Department for Child and Adolescent Psychiatry or at the “Maison des adolescents”, which is a primary care center for any adolescent issues. ResultsOur analyses support the hypothesis that radical engagement often soothes at first a preexisting psychological distress. The radicalization is more than a sociopolitical issue and more than the encounter of the adolescence process with a radical offer. Hence, in our group of adolescents, we have observed psychotic disorders, conversive and posttraumatic stress disorders and mainly depressive and narcissistic vulnerabilities. Our work reveals a variety of risk factors that are related to either family dynamics (fragility of inner family relationships, dysfunction of parental figures, parental depression or personality disorder…), or to individual fragilities (traumatic events during childhood, undiagnosed ADHD, depression, conduct disorder, etc.). Struggling against melancholic threats, the initial relief caused by the radicalization frequently contains paranoid mechanisms, which may lead to a violent acting out for some of these adolescents. ConclusionThe majority of radicalization processes in adolescence, understood as a new symptom in teenagers, justify a psychiatric evaluation including a broad assessment of childhood psychological vulnerabilities, in order to design a targeted personalized care program. More studies are required in order to further characterize the personal and parental vulnerabilities and underlying psychopathological mechanisms of radicalization processes in adolescence and to evaluate the efficiency of targeted care programs.

The two Bernard Berenson cousins: The interplay among immigration, culture, and narcissism

The lives of two 19th century cousins, both of whom changed their names to Bernard Berenson, are considered from historical and psychodynamic perspectives, using a psychobiographical method. The Jewish cousins immigrated separately to Boston from Lithuania in 1875 and 1882. One cousin, later calling himself simply B.B., became a world‐renowned art historian. The other Bernard became a misanthrope after feeling deeply humiliated by his cousin's family in Boston. Many biographies were written about the famous B.B. The only histories of his cousin Bernard were family stories, as he was the author's great‐grandfather. The intersecting lives of these cousins are discussed. Both men faced the challenges of immigration as well as intense anti‐Semitism and prejudice in each country in which they lived. These cultural and historical conditions interacted with the cousins’ narcissistic vulnerabilities. Their lives demonstrate different manifestations of narcissistic suffering, with B.B's being more consistent with the construct of a “grandiose narcissist” and Bernard's being more consistent with that of a “closet narcissist.” The life stories of these two cousins with the same name offers an intriguing instance of a complicated relationship among immigration, prejudice, and narcissism and case examples of the manifestation of how narcissistic suffering can influence lives.

Seeing Through the Fog: Learning to Work with Dissociation

Often the experience of learning from the patient is seamless, embedded in the unfolding clinical process. Patient and analyst bring their respective needs and capacities to this relationship and find new ways to collaborate toward the emotional growth of the patient, with the expectable amount of challenge and surprise along the way. Hopefully, analysts learn with every clinical encounter—but frequently it is when they are most challenged that they are aware of learning something particular from their patients about the therapeutic process. Patients with significant narcissistic vulnerabilities and corresponding narcissistic defenses can be quite challenging in treatment, especially in regards to the way that affects and whole sectors of the personality can be split-off and inaccessible in the treatment for a considerable time. It is the nature of this splitting-off, its subtle yet pervasive role in the treatment relationship, and the manner in which it led to both impasse and then insight, that became the focus of my learning from my patient. This article describes a treatment in which the dissociative process itself was dissociated, and how that came into awareness for both patient and analyst.

Guideline Watch (August 2012): Practice Guideline for the Treatment of Patients With Eating Disorders, 3rd Edition

This guideline watch reviews new evidence and highlights salient developments since the 2006 publication of APA’s Practice Guideline for the Treatment of Patients With Eating Disorders, 3rd Edition. The authors of this watch constituted the work group that developed the 2006 guideline. We find the guideline to remain substantially correct and current in its recommendations. The sole exception is a recommendation (with moderate-level confidence) for sibutramine for binge-eating disorder. In 2010, the U.S. Food and Drug Administration (FDA) withdrew approval for sibutramine because clinical trials showed increased risk of heart attack and stroke, and the manufacturer, Abbott Laboratories, subsequently withdrew this medication from the U.S. market. Noteworthy recent publications about the treatment of eating disorders include systematic reviews by the Agency for Healthcare Research and Quality (Berkman et al. 2006; Bulik et al. 2007); practice guidelines from international groups, including the Catalan Agency for Health Information, Assessment and Quality (Working Group of the Clinical Practice Guideline for Eating Disorders 2009), the World Federation of Societies of Biological Psychiatry (Aigner et al. 2011), and the German Society of Psychosomatic Medicine and Psychotherapy and the German College for Psychosomatic Medicine (Herpertz et al. 2011); and a 2011 guidance statement by the Academy for Eating Disorders, which was written by some of the authors of this

Cyrano de Bergerac: The Adventures of Narcissism in Edmond Rostand’s Heroic Comedy in Verse

The romantic comedy Cyrano de Bergerac has become a long-lasting and worldwide success since the play’s first opening in Paris in 1897. Using a psychoanalytic approach, the essay examines the narcissistic vulnerabilities of the character stigmatized by his large nose, Cyrano. It discusses the dualisms of splitting and ego integration, projective and introjective identifications, and the incarnation of an ideal self, as expressed in the play. Hidden under a plethora of words and acts of bravery lies Cyrano’s narcissistic pathology, whose story becomes the drama and demise of a phantasized state of perfection. Applying Hans Loewald’s theory of the ideal ego, Otto Kernberg’s concept of pathological narcissism, and André Green’s moral narcissism, the essay provides an exploration of the narcissistic pathology.

Identity Disturbance In Distant Patients

Chronically distant, emotionally isolated patients often present with identity disturbance. Identity, it is argued, develops as a thematic pattern of narcissism, shaped by the nature of the mother's early libidinal influences on the child's sense of self. Identity provides a form of self-definition that addresses the question, Who am I? In the treatment of these patients, resistances to narcissistic vulnerabilities (narcissistic resistances) provide an illusory sense of security and induce the analyst to avoid attention to a central pathological problem: primitive and frightening needs for, and unconscious fantasies of, dependence on, and functionality for, another. Patients' avoidance of material and therapeutic interactions that deal with their dependencies are aspects of a tacit contract with the analyst to foreclose examination of their considerable problems with inner stability. Among these problems are anxieties regarding intrusion and loss of separateness. As analysis proceeds, elements of such a patient's identity become clarified and are used to understand and organize the material for both analyst and patient. This can allow the patient to articulate a more embodied and vital experience of individuality. A case is presented to illustrate the analysis of a patient using this approach.

Restoring psychic containers of identity after a suicide attempt in adolescence

Suicidal acts during adolescence reveal narcissistic vulnerabilities. The author's observation concerns the quality of ego boundaries, as well as their evolution. Longitudinal studies were conducted on the basis of interviews and projective tests performed within 15 days after the suicide attempt and once again the following year. The quantitative analyses of Fisher and Cleveland's Barrier/Penetration scores on the Rorschach show the evolution of identity mechanisms. The results underscore the importance of restoring psychic containers of identity.

Narcissism and Sadomasochistic Relationships

People with narcissistic vulnerabilities often relate to others sadomasochistically-either exerting power, or submitting to others, or both-in order to manage their vulnerabilities and protect themselves from feelings of abandonment. Sadomasochistic experience often involves concrete thinking and limited playfulness or ability to use metaphor. In therapy, these difficulties are often actualized in the patient-therapist relationship so that usual verbal interpretations may be of limited value, and the therapist needs to work to maintain a mutually respectful relationship even as the patient tries to draw him/her into sadomasochistic interactions. Because these difficulties have roots in early childhood and are repeatedly reinforced by later experience, long-term treatment that provides ongoing opportunities for new experience and understanding will be most helpful. These ideas are illustrated with two case examples.

Finding a Compass in an Urban Storm: Toward the Use of a Self Psychological Perspective in Facilitating an African American Adolescent Self-Expression Group

This article begins an exploration of the efficacy of self psychology in groups of African American male adolescents. An example of its efficacious use is illustrated in the Male Responsibility Program's self-expression group. The selfobject experiences and narcissistic vulnerabilities of group members are used to conceptualize common problems facing young Black males. A new treatment approach is described that is a paradigm shift from the traditional models (mostly behavioral). It involves (a) new relational experiences with the therapist, peers, and eventually all significant others; (b) encouragement of exhibitionistic behavior (e.g., role play, performance art, verbal sharing, etc.); and (c) facilitation of a group exploration that will illuminate and transform selfobject needs, ways of organizing experience, and patterns of relating. Also, a new working model demonstrating the effects of racism on some Black males is provided. Finally, the benefits of nurturing a safe environment for exploration are discussed.

Why Is It So Difficult to Describe What Actually Goes On in the Minds of the Patient and Analyst?

The article is devoted to an exploration of the neglect of the whole person in describing what takes place in analysis. Without reference to the whole person, the humanism within the analytic situation is frequently absent; the question of finding a way to live with one's vulnerabilities and traumas is not addressed. The author suggests two major reasons for this situation: the adherence to the canons of science of the enlightenment and the lack of attention given to the transformation of the repetition compulsion into one's narrative which necessitates living with narcissistic injuries, vulnerabilities, and helplessness. Clinical vignettes are offered to demonstrate the author's argument.

P03-284 - Self-immolation of the soviet opponents in central Europe : suicidal behaviour or political protest?

IntroductionAround thirty of cases of public self-immolation occurred in Czechoslovakia, Poland and Lithuania between 1968 and 1972 in the background of protest movement against the Soviet ledinvasion. Rather than an act of a political protest, in a moment of absurdity of the existence, or a rational solution aimed to finish a desperate life situation, could a self-immolation also testify a suicidal behaviour and a failure of adaptation mechanisms of the victims concomitant a mental disorder?MethodWe have selected and studied four most mediated cases of this period. Press articles available in English, French and Czech, biographical writings and czech archived data concerning Palach J. R. Kalanta, J. Zajic and R. Siwiec allowed us to retrospectively analyse the circumstances of the acting out, their apparent or hidden motivations and identify their suicidal risk factors.ResultsAll the four victims were men, young single students, aged between 18 and 21 years, excepted from R. Siwiec, aged 60 years. None had a psychiatric history or abuse of alcohol. All four, in the opposition of the communist system, were surrounded by a supporting family background. The public character of their act highlights the opposition against a totalitarian system and is questionning the possible intentionality of their behavior or the identification process of the young adults in post-adolescence.ConclusionImmolation by fire of Soviet opponents in Central Europe should be revised in the light of the likely depression and narcissistic vulnerabilities of these subjects.

Threats to the Teaching Alliance

Ursano, Karthesier and Ursano’s insights on the teaching alliance provide a foundation for creating and maintaining an effective educational atmosphere in clinical training. Ursano and colleagues base their suggestions on the premise that teaching mental health professionals has an analog in the concept of the therapeutic alliance, a concept that has proven to be of great descriptive use in psychoanalysis as well as most, if not all, schools of psychotherapy. In the treatment situation, fostering an alliance is typically seen as the first and perhaps most important task of the therapist, as it is viewed as a prerequisite for future therapeutic efficacy. Greenson and Zetzel, referenced by the authors, spoke explicitly about the value of allying with the part of the patient that wished to be helped. The alliance, like any other interpersonal encounter involves transference (Brenner, 1979), but these analytic luminaries plus Ursano and colleagues see this as essentially a rational act, based in secondary process thinking. The authors do teachers a service by applying the lessons learned in the consultation room to the classroom. Attending to mutually understood goals, tasks, and expected resistances allows for the student and teacher to make good use of the opportunities for both the transfer of knowledge and identification with a learned instructor. When life is going well in the classroom or seminar, such success probably has something to do with the teacher wittingly or unwittingly following some or all of the clear prescriptions that Ursano and colleagues have outlined. The educational diagnosis of Ursano and colleagues is a useful template for the teacher to attend to some of the elements that facilitate establishing and maintaining the teaching alliance and repairing it when disrupted by individual dynamics, particularly narcissistic vulnerabilities. I infer that one of the reasons Ursano’s paper is published in Psychiatry rather than an educational journal is that there are elements of the subject matter of mental functioning and the experience of working with unconscious conflicts of our patients as well as our own that arise during this work that complicate and may undermine the rational basis upon which the teaching alliance is constructed. I think it may be useful to provide some additional thoughts on these and other sources of interferences. Freud (1937) listed psychoanalysis as one of the three impossible professions in his gloomy but seminal contribution, Analysis Terminable and Interminable. It is less commonly known that education is one of the others (government was the third). Succeeding as a psychoanalyst was seen as impossible bePsychiatry 70(3) Fall 2007 200

Narcissistic Vulnerabilities at Midlife: Supporting the Self in Challenging Times

Narcissistic Vulnerabilities at Midlife: Supporting the Self in Challenging Times

Treatment Considerations When Working with Pathological Narcissism

The author presents his understanding and experience of working with clients who exhibit pathological narcissism. Some of the challenges that arise in the treatment process are considered from a psychodynamic perspective, particularly how destructive elements manifest themselves and impact the therapeutic relationship. After a brief overview of various theories, the etiology of narcissism, transference issues, and narcissistic vulnerabilities, the author focuses on pathological processes, particularly destructive elements. The challenge of working with these issues is described, including the way the defenses of the narcissistically organized client are threatened by the separateness of the client and the therapist. The article concludes with an examination of those aspects of treatment that must be considered when undertaking psychotherapy with narcissistic individuals, particularly from a relational orientation.

The Loudness of the Unspoken: Candidates' Anxiety in Supervision

This paper examines the candidate's anxiety in supervision and its detrimental impact on the candidate's training and quality of life. It looks closely at the various sources of candidates' anxiety emphasizing the iatrogenic anxiety engendered in the supervisory encounter per se. Some of the issues discussed are: apprehension of self-exposure; intrusion into the intimate hour; narcissistic vulnerabilities; dependency and boundary issues; interpersonal/intersubjective anxieties; anxieties inherent in the multiple-role relationship with the supervisor and the institute; evaluation, confidentiality, safety, and trust. The article concludes with a plea to the psychoanalytic community to attend to the high level of candidates' anxiety and the heavy burden an outdated model of supervision puts on the shoulders of both supervisors and supervisees. It emphasizes the urgent need to introduce the necessary changes in the structure of supervision in psychoanalytic institutes.

Narcissistic Vulnerability and the Development of PTSD

This study empirically examined the role of narcissistic traits and narcissistic vulnerability in the development of post-traumatic stress disorder (PTSD). One hundred forty-four survivors of a traumatic event were assessed 1 week, 1 month, and 4 months following the event. In the first-week assessment, patients were administered the Narcissistic Vulnerability Scale and self-reported rating scale to assess event severity and symptoms ensuing from the impact of the traumatic event: depression, intrusions, avoidance, and arousal. In the follow-up assessments, subjects were interviewed on the Clinician-Administered PTSD Scale and were readministered the self-rating symptoms scale. Survivors who developed acute (1 month) and chronic (4 months) PTSD had significantly higher levels of narcissistic vulnerability in the first-week assessment. Narcissistic Vulnerability Scale scores predicted PTSD status with sensitivity of 81.6% and 85.1% and specificity of 40.4% and 38.6% at the 1-month and 4-month assessments, respectively. Narcissistic vulnerabilities contribute to the occurrence of PTSD.

Élaboration des problématiques narcissiques par le psychodrame individuel en groupe d'adolescents

The authors depict the functioning of a psychoanalytic psychodrama regrouping young adolescents with narcissistic vulnerabilities. Sessions show a strong appeal to primitive fantasies embodied in totemic characters and an universal heritage background. This rich figuration of anxious affects leads to the building up of a mythic theory of origins, which encompasses the history of the group and the participants' roots. As a protective shield for the group, the leader secures the session progression and the therapeutic frame. Such psychodrama techniques allow for the working through of narcissistic issues while avoiding direct confrontation to the youths' narcissistic injuries.

The Problem of Narcissism in Psychoanalytic Organizations: The Insularity of Power

The author reviews a facet of the history of psychoanalytic institutes from the perspective of Freud's defensive idealisations and grandiosity against narcissistic vulnerabilities that contributed to organizational difficulties. The idealizations and grandiosity were expressed in a rigid, repetitive preoccupation with protecting psychoanalysis through use of secrecy, insularity, control of power, and intolerance of diverse opinions of others. Eventually, insulating power became institutionalized, and it has interfered with a more consonant expression of the humane processes of psychoanalysis in the activities of psychoanalytic organizations. Over the past 20 years, however, several events have allowed analysts to use their increased knowledge of narcissism to tolerate their narcissistic vulnerabilities so they could use this understanding in their practice, in their psychoanalytic organizations, and in their lives. One effect of this development is that psychoanalytic organizations are undergoing constructive changes.

Narcissism, eroticism, and envy in the supervisory relationship.

Supervision takes place in a framework of time, place, and duration agreed upon by teacher and student. But beyond the formal arrangements of supervision lie a host of behaviors that express conscious and unconscious fears and wishes that are aroused in student and teacher by their meetings. This paper focuses on supervisors' motivations for teaching, and the ways in which their narcissistic vulnerabilities and their feelings for their students may influence the frame of supervision and its outcome.