Skip to content mytopbookspace. Author : Anthony D. Wide-ranging expert coverage examines the many manifestations of narcissism, including grandiose, vulnerable, communal, and collective varieties. Chapters explore associated personality traits and numerous other important correlates of narcissistic personality.
New approaches to research, assessment methods, and opportunities for intervention—both immediate and long-term, are discussed throughout. In addition, trait narcissism is examined in an even-handed manner that incorporates state-of-the-art research into antecedents and consequences both good and bad of narcissistic personality. Among the topics in the Handbook: What separates narcissism from self-esteem? A social-cognitive perspective.
The many measures of grandiose narcissism. What do narcissists know about themselves? It should be remembered that others are not seen as persons in their own right but rather experienced and used as instruments. In our clinical experience, therapists and others are most valued if they maintain an emotional distance and refrain from empathic interventions.
The need for personal gain can easily be misunderstood: the benefit is found in the enhancement of the subjective self. The instrumentality of relationships is a defense against the unbearable feeling of being dependent on the relationship Kernberg, , Characteristically, others are usually idealized or devaluated excessively and inappropriately.
Hyper-idealizing someone also places the patient in the position of being the one who has the expertise to judge, which fuels feelings of superiority. Because if you are, how can you help me with my relational problems when you can't handle them yourself? Idealization and devaluation are associated with an insecure dismissing-avoidant attachment style Tolmacz and Mikulincer, Ambivalence is seldom cherished as a valuable state of mind; instead, relations are about winning or losing, and jealousy is omni-present.
Anything with relational implications will be dismissed if it might give pleasure and make one emotionally alive. Describing the basic relational patterns of patients with NPD, Lachkar writes that their partners are quite often diagnosed with BPD. It is a tale of the deaf leading the blind and, usually, the relationship falters when the partner with BPD matures and becomes less dependent and anxious.
Sexuality in relationships is often complicated. Sexuality is often reduced to a mere physical pleasure, whether or not permeated with fantasies of being the greatest lover. Extreme self-centeredness or other-centeredness during lovemaking is characteristic, as reciprocity and empathic attunement are avoided. His self-worth as a great lover crumbled. Sexuality can turn into perverse love: sexual excitement becomes the substitute for love and the longing of the other serves to strengthen the cohesion in the self.
The own body, the other's body, or a fetish becomes a sexual object, an eroticized self which is constantly longing for stimulation Akhtar, It is not uncommon to find NPD patients who also suffer from hypochondria: the frail implicit self has developed alongside a frail bodily self. It should be remembered that the AMPD characterizes each personality disorder on the basis of a specific pattern of personality dysfunctions and traits. In the section above, we described the patterns of this pattern in NPD by looking at a unique pattern of self-impairments, which are evaluated by focusing on identity and self-direction, and of interpersonal functioning, which is evaluated by focusing on empathy and intimacy.
We now turn to the unique trait profile of NPD: grandiosity and attention seeking. The description of feelings of entitlement, either overt or covert, fits in well with Pincus and Lukowitsky's suggestion that grandiose and vulnerable narcissism can be expressed both overtly and covertly and, consequently, that feelings of entitlement should not only be associated with grandiose narcissism.
This perspective confirms our clinical experience but it is, at the same time, subject to some theoretical discussion. In the PDM-2, which focuses on personality styles and not on personality disorders, entitlement is mentioned only as a pattern in adolescents with narcissism Lingiardi and McWilliams, The same applies to clinging to the belief that one is better than others and condescension toward others.
These characteristics can also be seen in both expressions of narcissism, and particularly in masochistic narcissism: the grandiosity of suffering is hidden by silently and secretly experiencing the grandiosity of being able to bear any adverse events Fairbairn, ; Kernberg, Entitlement and condescension are two characteristics of narcissism that have given narcissism its negative connotation in everyday speech.
In psychodynamic theory, there is a close association between the nature of entitlement and a defensive wilful resistance to dependency and reciprocity.
Patients wilfully decline to relate with another in order to get what they want; instead, they expect it to be served or granted without having to ask explicitly.
Asking is about losing, as asking would acknowledge neediness and dependency. Research has shown that excessive and restricted forms of relational entitlement are significantly associated with insecure attachment styles Tolmacz and Mikulincer, In the clinical situation, we encounter patients who literally refuse to give up their entitlement.
Their narcissistic rage is fuelled to no purpose by a feeling of entitlement and by the demand to be compensated for the misdeeds or shortcomings of persons or circumstances in the past. In our consulting room, we meet patients who cannot cut their losses with respect to situations in the past and, in their hate, remain attached to a parent in an obsessive and spiteful way.
Working through this persistence is often painstakingly difficult because the rage prevents patients from establishing the psychological distance through the self-as-object that is necessary to see the insanity of their expectations.
Again, it is easy to associate these criteria with overt narcissism and therefore fail to notice covert attention-seeking involving putting others in the spotlight. The essence of this latter type of self-esteem regulation is that patients subconsciously see their self-effacing behavior in the service of the well-being of others as support for their self-esteem.
However—and this is essential—the relationship with the other is instrumental and can therefore be perceived by the other as manipulative. In intersubjective terms: the other is treated as an object that possesses conditional value. Attention seeking therefore involves not only seeking admiration for oneself directly; it also includes forms of behavior in which admiration is given to others.
In this article we integrated Pincus and Lukowitsky's hierarchical model of pathological narcissism, contemporary psychodynamic concepts of narcissism, and the diagnostic concept of narcissism in the AMPD. Pincus and Lukowitsky encourage clinicians to use this hierarchical model as it opens up opportunities for shared points of interest in empirical research from different scholarly perspectives. Capacities for self-regulation and emotion regulation can, for example, be operationalized from social-learning theory and from a psychodynamic perspective, with each adding valuable knowledge.
Pincus and Lukowitsky's valuable review showed there has been hardly any research into NPD with a clinical patient sample. More research involving a clinical sample is therefore needed. In addition, researchers could adapt their methods in order to conduct research that is clinically relevant for mental health care by focusing on phenomena that can be addressed in psychotherapeutic treatment. Pincus and Lukowitsky's review also showed that narcissism research is skewed by the use of the Narcissistic Personality Inventory, which mostly assesses adaptive expressions of grandiose narcissism.
In the hierarchical model, vulnerable narcissism emerges as a relatively new concept for non-psychodynamically informed researchers and therapists, and additional measures have to be developed to cover this concept. For us, one of the major advantages of the AMPD is the use of structured clinical evaluations of disturbances of the self and interpersonal functioning. In the present paper, we have discussed at length the thematic content of the AMPD. As psychodynamically oriented therapists, we are enthusiastic about the opportunities to include psychodynamic and structural concepts see also: Bornstein, In addition to the thematic content, we welcome the dimensional evaluation of the severity of personality disorder pathology.
This provides the practitioner with information about the prognosis and the indication for the treatment model Caligor and Stern, We also acknowledge that there are a number of discussion points. Following the example of all psychodynamic theories, the AMPD assumes in the case of NPD that there is a disturbance that goes back to early child development.
However, in all honesty, there is still no empirically derived theory for the etiology of grandiose and vulnerable narcissism, even though there is now more research with children from researchers like Brummelman et al. Relational psychodynamic theory has undeniably been supplemented with clinical child research into attachment, mentalization, emotion regulation, and parenting styles.
It is, however, unfortunate that research has also shown that the link between childhood experiences and later emotional disturbances is relatively weak.
More empirical data about attachment styles and emotion regulation styles in patients with narcissistic pathology would be welcome as support for the unique pattern of narcissistic relational dynamics. In the final evaluation of the four AMPD DSM-5 elements of personality functioning, all the elements seem to have equal importance but clinical experience and psychodynamic clinical theory clearly place most emphasis on the element of identity, with self-regulation and emotion regulation as the most important aspect of this element.
This problem can be resolved by further research into the relative importance of the four elements of personality dysfunction. The need to evaluate the severity of impairment in personality functioning is a valuable element in the proposed diagnostic criteria for NPD that psychodynamically oriented therapists could use to their benefit. We believe that the criteria for the two personality traits, grandiosity and attention seeking, rely too heavily on the definition of NPD in the traditional DSM-5, with its focus on grandiose narcissism.
However, further research could determine whether only these two traits pertain to NPD or if other traits might be relevant as well. Future research using the Level of Personality Functioning Scale, as proposed in the AMPD, will provide ample opportunities for introducing a more sophisticated psychodynamic perspective. The AMPD comes close to how psychoanalytic therapists could conceptualize their daily practice see also: Caligor and Stern, 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.
However, understandably, the basic tenet in clinical theory that distancing from the significant other forms the basis for developing NPD is not operationalized in the AMPD. Ultimately, this distancing can only be clinically inferred by assessing its consequences, which are described in the AMPD. Now, after all this theory, the proof of the pudding is once again in the eating.
In our case, the proof is to be found in the therapies we provide. Many guidelines for treating pathological narcissism have been developed in the last 10 years. Nevertheless, others focus on specific themes when treating pathological narcissism, for example in psychodynamic therapy Crisp and Gabbard, or the client-centered Clarification-Oriented Psychotherapy Maillard et al. Traditional high-frequency psychoanalysis—three to five weekly sessions on the couch—seems to have missed the boat in terms of establishing a position in the discussion.
A process model Grapsas et al. It comes from the field of social learning and experimental psychology. Almost none of the references in that paper overlap with those in the present paper. Given the realization that there are so many overlaps, it is shocking that we seem to know so little about each other's work. For example, both fields look at internal processing in subjects with narcissism. Grapsas et al. In the same way, Ronningstam b draws attention to internal processing in patients and how it contributes to narcissistic personality functioning.
Narcissism seems to be associated with many bioneurological phenomena that are prototypical for narcissism. Ronningstam argues that more attention should be paid to all kinds of internal processing from a neuropsychoanalytic point of view. As in the treatment of traumatized patients, this approach could inform the therapist in therapeutic stalemates. Affective neuroscience can enlighten the neurological correlates of our subjective states.
This is the self-system Schore calls the implicit self, associated with the unrepressed unconscious. In the first year of life, the structuralization of the right brain self develops in the course of the interdependent interaction between child and caretakers self-objects , especially through processes of mismatch and repair in attachment, and with it mal adaptive implicit self-regulation processes develop.
In early development, this implicit self, supposedly located in the lateralized right brain, is basically relational, as the self-states develop out of the interaction with the self-objects. Schore , locates the brain's major self-regulatory systems in the orbital prefrontal areas of the right hemisphere. Its functioning belongs to the unrepressed unconscious; its content can be felt but cannot be translated into words or symbols.
Accordingly, in psychotherapy, it cannot be reached through interpretations making the unconscious conscious, but it becomes visible in enactments between psychoanalyst and patient.
The central challenge in the decade to come would seem to be to differentiate between NPD from BPD and to establish specific recommendations for treatment.
Indeed, we agree with the comment made by Choi-Kain that was quoted in the introduction of this paper, that we can now look ahead to a new wave of investigation and treatment development. All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors want to thank Lois Choi-Kahn for her comments on an earlier draft of this paper and Laura Muzi and Andrea Scalabrini for their helpful comments during the review process.
National Center for Biotechnology Information , U. Front Psychol. The many measures of grandiose narcissism. What do narcissists know about themselves? Interpersonal functioning of narcissistic individuals and implications for treatment engagement. Offering nuanced analysis of a particularly timely subject, The Handbook of Trait Narcissism is fascinating and informative reading for psychologists and psychology students, as well as scholars in anthropology, sociology, economics, political scientists, and more.
Author : John F. New York, NY: Springer. Theory and empirical evidence. European Journal of Back Examining the mediating role of In Handbook of Trait Narcissism pp. It is crucial for treating clinicians to be aware that there are high rates of drop-outs and increased rates of therapeutic disruption with persons with a narcissistic personality disorder.
It is essential to recognize that most clinicians experience negative countertransference when treating persons with NPD. Clinicians are advised to be aware of the same and process emotions that arise in treatment. Enhancing Healthcare Team Outcomes Often collaborative work is required in the medical setting when patients with NPD work with non-mental health professionals such as surgeons, medical nursing, nutritionists, etc.
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