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Current Behavioral Neuroscience Reports

, Volume 3, Issue 1, pp 34–42 | Cite as

Pathological Narcissism and Narcissistic Personality Disorder: Recent Research and Clinical Implications

  • Elsa Ronningstam
Personality and Impulse Control Disorders (R Lee, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Personality and Impulse Control Disorders

Abstract

This review is focused on integrating recent research on emotion regulation and empathic functioning with specific relevance for agency, control, and decision-making in narcissistic personality disorder (NPD, conceptualized as self direction in DSM 5 Section III). The neuroscientific studies of emotion regulation and empathic capability can provide some significant information regarding the neurological/neuropsychological underpinnings to narcissistic personality functioning. Deficiencies in emotion processing, compromised empathic functioning, and motivation can influence narcissistic self-regulation and agential direction and competence in social interactions and interpersonal intimate relationships. The aim is to expand our understanding of pathological narcissism and NPD and suggest relevant implications for building a collaborative treatment alliance.

Keywords

Narcissistic personality disorder Pathological narcissism Empathy Suicide Emotion regulation Agency 

Notes

Compliance with Ethical Standards

Conflict of Interest

Elsa Ronningstam declares no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.••
    Caligor E, Levy KN, Yeomans FE. Narcissistic personality disorder: diagnostic and clinical challenges. Am J Psychiatry. 2015;172(5):415–22. doi: 10.1176/appi.ajp.2014.14060723. Excellent most recent informative overview of narcissistic personality disorder.CrossRefPubMedGoogle Scholar
  2. 2.
    Ronningstam E. Narcissistic personality disorder: facing DSM-V. Psychiatr Ann. 2009;39(3):111–21.CrossRefGoogle Scholar
  3. 3.
    Ronningstam E. An update on narcissistic personality disorder. Curr Opin Psychiatry. 2013;26(1):102–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Pincus AL, Lukowitsky MR. Pathological narcissism and narcissistic personality disorder. Annu Rev Clin Psychol. 2010;6:421–46.CrossRefPubMedGoogle Scholar
  5. 5.
    Ronningstam E, Weinberg I. Narcissistic personality disorder—progress in recognition and treatment. American Psychiatric Association. Focus: J Lifelong Learn Psychiatry. 2013;11(2):167–77.Google Scholar
  6. 6.
    Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2008;69(7):1033–45.PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Torgersen S, Myers J, Reichborn Kjennerud T, Røysamb E, Kubarych TS, Kendler KS. The heritability of cluster B personality disorders assessed both by personal interview and questionnaire. J Personal Disord. 2012;26(6):84866. doi: 10.1521/pedi.2012.26.6.848.Google Scholar
  8. 8.
    Tritt SM, Ryder AG, Ring AJ, Pincus AL. Pathological narcissism and the depressive temperament. J Affect Disord. 2010;122(3):280–4. doi: 10.1016/j.jad.2009.09.006.CrossRefPubMedGoogle Scholar
  9. 9.
    Simon RI. Distinguishing trauma-associated narcissistic symptoms from posttraumatic stress disorder: a diagnostic challenge. Harv Rev Psychiatry. 2002;10(1):28–36.CrossRefPubMedGoogle Scholar
  10. 10.
    Maldonado JL. Vicissitudes in adult life resulting from traumatic experiences in adolescence. Int J Psychoanal. 2006;87(5):1239–57.CrossRefPubMedGoogle Scholar
  11. 11.
    Kernberg P. Developmental aspects of normal and pathological narcissism. In: Ronningstam E, editor. Disorders of narcissism: diagnostic, clinical and empirical implications. Washington, DC: American Psychiatric Press; 1998. p. 103–20.Google Scholar
  12. 12.
    Diamond D, Clarkin JF, Levy KN, Meehan KB, Cain NM, Yeomans FE, et al. Change in attachment and reflective function in borderline patients with or without narcissistic personality disorder in transference focused psychotherapy. Contemp Psychoanal. 2014;50(1-2):175–201.CrossRefGoogle Scholar
  13. 13.
    Diamond D, Meehan KB. Attachment and object relations in patients with narcissistic personality disorder: implications for therapeutic process and outcome. J Clin Psychol. 2013;69(11):1148–59. doi: 10.1002/jclp.22042.CrossRefPubMedGoogle Scholar
  14. 14.
    Meyer B, Pilkonis PA. Attachment theory and narcissistic personality disorder. In: Campbell K, Miller J, editors. The handbook of narcissism and narcissistic personality disorder: theoretical approaches, empirical findings, and treatments. Hoboken: Wiley; 2011. p. 434–44.Google Scholar
  15. 15.
    Fiscalini J. Narcissism and co-participant inquiry—explorations in contemporary interpersonal psychoanalysis. Contemp Psychoanal. 1994;30(4):747–76.CrossRefGoogle Scholar
  16. 16.
    Young J, Flanagan C. Schema-focused therapy for narcissistic patients. In: Ronningstam E, editor. Disorders of narcissism—diagnostic, clinical, and empirical implications. Washington DC: American Psychiatric Press; 1998. p. 239–68.Google Scholar
  17. 17.
    McLean J. Psychotherapy with a narcissistic patient using Kohut’s self psychology model. Psychiatry (Edgmont). 2007;4(10):40–7.Google Scholar
  18. 18.
    Dimaggio G, Attinà G. Metacognitive interpersonal therapy for narcissistic personality disorder and associated perfectionism. J Clin Psychol. 2012;68(8):922–34. doi: 10.1002/jclp.21896.CrossRefPubMedGoogle Scholar
  19. 19.
    Ronningstam E. Alliance building and the diagnosis of narcissistic personality disorder. J Clin Psychol. 2012;68(8):943–53.CrossRefPubMedGoogle Scholar
  20. 20.
    Freeman A, Fox S. Cognitive behavioral perspectives on the theory and treatment of the narcissistic character. In: Ogrodniczuk JS, editor. Understanding and treating pathological narcissism. Washington, DC: American Psychological Association; 2013. p. 301–19.CrossRefGoogle Scholar
  21. 21.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.Google Scholar
  22. 22.
    Vater A, Ritter K, Strunz S, Ronningstam EF, Renneberg B, Roepke S. Stability of narcissistic personality disorder: tracking categorical and dimensional rating systems over a two-year period. Pers Disord Theory Res Treat. 2014;5(3):305–13. doi: 10.1037/per0000058.CrossRefGoogle Scholar
  23. 23.
    Ronningstam E, Gunderson J, Lyons M. Changes in pathological narcissism. Am J Psychiatr. 1995;152:253–7.CrossRefPubMedGoogle Scholar
  24. 24.••
    Roepke S, Vater A. Narcissistic personality disorder: an integrative review of recent empirical data and current definitions. Curr Psychiatry Rep. 2014;16(5):445. doi: 10.1007/s11920-014-0445-0. Provides a comprehensive overview of research that currently support the definitions and clinical conceptualization of NPD.CrossRefPubMedGoogle Scholar
  25. 25.
    Gabbard GO. Mind, brain, and personality disorders. Am J Psychiatry. 2005;162(4):648–55.CrossRefPubMedGoogle Scholar
  26. 26.
    Decety J, Moriguchi Y. The empathic brain and its dysfunction in psychiatric populations: implications for intervention across different clinical conditions. Biopsychosoc Med. 2007;1:22. doi: 10.1186/1751-0759-1-22. 1-21.PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Fonagy P, Gergely G, Jurist LJ, Target M. Affect regulation, mentalization and the development of the self. New York: Other Press; 2002.Google Scholar
  28. 28.
    Gallagher A. Multiple aspects in sense of agency. New Ideas Psychol. 2012;30(1):51–31.CrossRefGoogle Scholar
  29. 29.••
    Ellison WD, Levy KN, Cain NM, Ansell EB, Pincus AL. The impact of pathological narcissism on psychotherapy utilization, initial symptom severity, and early-treatment symptom change: a naturalistic investigation. J Pers Assess. 2013;95(3):291–300. doi: 10.1080/00223891.2012.742904. Informative and clinically relevant article that is specifically helpful for understanding challenges in initial alliance building.CrossRefPubMedGoogle Scholar
  30. 30.
    Hilsenroth MJ, Castelbury FD, Holdwick DJ, Blais MA. The effects of DSM-IV cluster B personality disorder symptoms on the termination and continuation of psychotherapy. Psychotherapy. 1998;35(2):163–76.CrossRefGoogle Scholar
  31. 31.
    Kernberg OF. The almost untreatable narcissistic patient. J Am Psychoanal Assoc. 2007;55(2):503–39.CrossRefPubMedGoogle Scholar
  32. 32.
    Tanzilli A, Colli A, Muzi L, Lingiardi V. Clinician emotional response toward narcissistic patients: a preliminary report. Res Psychother Psychopathol Process Ourtcome. 2015;18(1):1–9.Google Scholar
  33. 33.
    Sassenrath C, Sassenberg K, Ray DG, Scheiter K, Jarodzka H. A motivational determinant of facial emotion recognition: regulatory focus affects recognition of emotions in faces. PLoS One. 2014;9(11):e112383. doi: 10.1371/journal.pone.0112383.PubMedCentralCrossRefPubMedGoogle Scholar
  34. 34.
    Baskin-Sommers A, Krusemark E, Ronningstam E. Empathy in narcissistic personality disorder: from clinical and empirical perspectives. Personal Disord. 2014;5(3):323–33. doi: 10.1037/per0000061.PubMedCentralCrossRefPubMedGoogle Scholar
  35. 35.
    Gabbard GO. Countertransference issues in the treatment of pathological narcissism. In: Ogrodniczuk JS, editor. Understanding and treating pathological narcissism. Washington, DC: American Psychological Association; 2013. p. 207–17.CrossRefGoogle Scholar
  36. 36.
    Swett AD. When therapeutic worlds collide? On Bion’s concept of reversible perspective: a brief review and clinical case illustration. Int Forum Psychoanal. 2011;20:38–44.CrossRefGoogle Scholar
  37. 37.
    Nenadic I, Güllmar D, Dietzek M, Langbein K, Steinke J, Gaser C. Brain structure in narcissistic personality disorder: a VBM and DTI pilot study. Psychiatry Res. 2015;231(2):184–6. doi: 10.1016/j.pscychresns.2014.11.001.CrossRefPubMedGoogle Scholar
  38. 38.
    Schulze L, Dziobek I, Vater A, Heekeren HR, Bajbouj M, Renneberg B, et al. Gray matter abnormalities in patients with narcissistic personality disorder. J Psychiatr Res. 2013;47(10):1363–9. doi: 10.1016/j.jpsychires.2013.05.017. Epub 2013 Jun 15.CrossRefPubMedGoogle Scholar
  39. 39.
    Sylvers P, Brubaker N, Alden SA, Brennan PA, Lilienfeld SO. Differential endophenotypic markers of narcissistic and antisocial personality features: a psychophysiological investigation. J Res Pers. 2008;42:1260–70. doi: 10.1016/j.jrp2008.03.010.CrossRefGoogle Scholar
  40. 40.
    Krystal H. Affect regulation and narcissism: trauma, alexithymia and psychosomatic illness in narcissistic patients. In: Ronningstam E, editor. Disorders of narcissism: diagnostic, clinical and empirical implications. Washington, DC: American Psychiatric Press; 1998. p. 299–326.Google Scholar
  41. 41.
    Lawson R, Waller G, Sines J, Meyer C. Emotional awareness among eating-disordered patients: the role of narcissistic traits. Eur Eat Disord Rev. 2008;16(1):44–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Fan Y, Wonneberger C, Enzi B, de Greck M, Ulrich C, Tempelmann C, et al. The narcissistic self and its psychological and neural correlates: an exploratory fMRI study. Psychol Med. 2011;41(8):1641–50. doi: 10.1017/S003329171000228X.CrossRefPubMedGoogle Scholar
  43. 43.
    Denecke FW, Hilgerstock B. The narcissism inventory. Bern: Hans Huber; 1989.Google Scholar
  44. 44.
    Mizen CS. Narcissistic disorder and the failure of symbolization: a relational affective hypothesis. Med Hypotheses. 2014;83(3):254–62. doi: 10.1016/j.mehy.2014.05.012.CrossRefPubMedGoogle Scholar
  45. 45.
    Bonomi C. Trauma and the symbolic function of the mind. Int Forum Psychoanal. 2004;13:45–50.CrossRefGoogle Scholar
  46. 46.
    Marissen MA, Deen ML, Franken IH. Disturbed emotion recognition in patients with narcissistic personality disorder. Psychiatry Res. 2012;198(2):269–73. doi: 10.1016/j.psychres.2011.12.042.CrossRefPubMedGoogle Scholar
  47. 47.
    Ronningstam E. Identifying and understanding the narcissistic personality. Oxford University Press 2005.Google Scholar
  48. 48.
    Ronningstam E. Narcissistic personality disorder—a current review. Curr Psychiatry Rep. 2010;12:68–17.CrossRefPubMedGoogle Scholar
  49. 49.
    Ritter K, Vater A, Rüsch N, Schröder-Abé M, Schütz A, Fydrich T, et al. Shame in patients with narcissistic personality disorder. Psychiatry Res. 2014;215(2):429–37. doi: 10.1016/j.psychres.2013.11.019.CrossRefPubMedGoogle Scholar
  50. 50.
    Sagar SS, Stoeber J. Perfectionism, fear of failure, and affective responses to success and failure: the central role of fear of experiencing shame and embarrassment. J Sport Exerc Psychol. 2009;31(5):602–27.PubMedGoogle Scholar
  51. 51.
    Horowitz MJ. Clinical phenomenology of narcissistic pathology. Psychiatr Clin N Am. 1989;12(3):531–9.Google Scholar
  52. 52.
    Kernberg OF. The destruction of time in pathological narcissism. Int J Psychoanal. 2008;89(2):299–312. doi: 10.1111/j.1745-8315.2008.00023.x.CrossRefPubMedGoogle Scholar
  53. 53.
    Ronningstam E, Baskin-Sommers A. Fear and decision-making in narcissistic personality disorder—a link between psychoanalysis and neuroscience. Dialogues Clin Neurosci. 2013;15(2):191–201.PubMedCentralPubMedGoogle Scholar
  54. 54.
    Ronningstam E, Weinberg I, Maltsberger J. Eleven deaths of Mr. K—contributing factors to suicide in narcissistic personalities. Psychiatry Interpersonal Biol Proc. 2008;71(2):169–82.CrossRefGoogle Scholar
  55. 55.
    Kernberg OF. Aggression in personality disorders and perversions. New Haven: Yale University Press; 1992.Google Scholar
  56. 56.
    Maltsberger JT, Ronningstam E, Weinberg I, Schechter M, Goldblatt MJ. Suicidal fantasy as a life sustaining recourse. J Am Acad Psychoanal Dyn Psychiatry. 2010;38(4):611–24.CrossRefPubMedGoogle Scholar
  57. 57.
    Singer T. The neuronal basis and ontogeny of empathy and mind reading: review of literature and implications for future research. Neurosci Biobehav Rev. 2006;30(6):855–63.CrossRefPubMedGoogle Scholar
  58. 58.
    Decety J, Jackson PL. The functional architecture of human empathy. Behav Cogn Neurosci Rev. 2004;3(2):71–100.CrossRefPubMedGoogle Scholar
  59. 59.
    Ritter K, Dziobek I, Preissler S, Rüter A, Vater A, Fydrich T, et al. Lack of empathy in patients with narcissistic personality disorder. Psychiatry Res. 2011;187(1-2):241–7. doi: 10.1016/j.psychres.2010.09.013.CrossRefPubMedGoogle Scholar
  60. 60.
    Dziobek I, Rogers K, Fleck S, Bahnemann M, Heekeren HR, Wolf OT, et al. Dissociation of cognitive and emotional empathy in adults with Asperger syndrome using the Multifaceted Empathy Test (MET). J Autism Dev Disord. 2008;38(3):464–73.CrossRefPubMedGoogle Scholar
  61. 61.••
    Marcoux LA, Michon PE, Lemelin S, Voisin JA, Vachon-Presseau E, Jackson PL. Feeling but not caring: empathic alteration in narcissistic men with high psychopathic traits. Psychiatry Res. 2014;224(3):341–8. doi: 10.1016/j.pscychresns.2014.10.002. Informative article that clarifies significant aspects of empathic functioning and differences between cognitive and emotional empathy in patients with NPD.CrossRefPubMedGoogle Scholar
  62. 62.
    Blasco-Fontecilla H, Baca-Garcia E, Dervic K, Perez-Rodriguez MM, Lopez-Castroman J, Saiz-Ruiz J, et al. Specific features of suicidal behavior in patients with narcissistic personality disorder. J Clin Psychiatry. 2009;70(11):1583–7. doi: 10.4088/JCP.08m04899.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2016

Authors and Affiliations

  1. 1.Department of Psychiatry, Harvard Medical School, Faculty, Boston Psychoanalytic Society and InstituteMcLean HospitalBelmontUSA

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