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

Current Behavioral Neuroscience Reports volume 3, pages 34–42 (2016)Cite this article

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.

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References

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

  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.

    Article  PubMed  Google Scholar 

  2. Ronningstam E. Narcissistic personality disorder: facing DSM-V. Psychiatr Ann. 2009;39(3):111–21.

    Article  Google Scholar 

  3. Ronningstam E. An update on narcissistic personality disorder. Curr Opin Psychiatry. 2013;26(1):102–6.

    Article  PubMed  Google Scholar 

  4. Pincus AL, Lukowitsky MR. Pathological narcissism and narcissistic personality disorder. Annu Rev Clin Psychol. 2010;6:421–46.

    Article  PubMed  Google Scholar 

  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. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  9. Simon RI. Distinguishing trauma-associated narcissistic symptoms from posttraumatic stress disorder: a diagnostic challenge. Harv Rev Psychiatry. 2002;10(1):28–36.

    Article  PubMed  Google Scholar 

  10. Maldonado JL. Vicissitudes in adult life resulting from traumatic experiences in adolescence. Int J Psychoanal. 2006;87(5):1239–57.

    Article  PubMed  Google Scholar 

  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. 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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. Fiscalini J. Narcissism and co-participant inquiry—explorations in contemporary interpersonal psychoanalysis. Contemp Psychoanal. 1994;30(4):747–76.

    Article  Google Scholar 

  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. McLean J. Psychotherapy with a narcissistic patient using Kohut’s self psychology model. Psychiatry (Edgmont). 2007;4(10):40–7.

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  19. Ronningstam E. Alliance building and the diagnosis of narcissistic personality disorder. J Clin Psychol. 2012;68(8):943–53.

    Article  PubMed  Google Scholar 

  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.

    Chapter  Google Scholar 

  21. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

    Google Scholar 

  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.

    Article  Google Scholar 

  23. Ronningstam E, Gunderson J, Lyons M. Changes in pathological narcissism. Am J Psychiatr. 1995;152:253–7.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  25. Gabbard GO. Mind, brain, and personality disorders. Am J Psychiatry. 2005;162(4):648–55.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed Central  PubMed  Google Scholar 

  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. Gallagher A. Multiple aspects in sense of agency. New Ideas Psychol. 2012;30(1):51–31.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  31. Kernberg OF. The almost untreatable narcissistic patient. J Am Psychoanal Assoc. 2007;55(2):503–39.

    Article  PubMed  Google Scholar 

  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. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  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.

    Article  PubMed Central  PubMed  Google Scholar 

  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.

    Chapter  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  43. Denecke FW, Hilgerstock B. The narcissism inventory. Bern: Hans Huber; 1989.

    Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  45. Bonomi C. Trauma and the symbolic function of the mind. Int Forum Psychoanal. 2004;13:45–50.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  47. Ronningstam E. Identifying and understanding the narcissistic personality. Oxford University Press 2005.

  48. Ronningstam E. Narcissistic personality disorder—a current review. Curr Psychiatry Rep. 2010;12:68–17.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  51. Horowitz MJ. Clinical phenomenology of narcissistic pathology. Psychiatr Clin N Am. 1989;12(3):531–9.

    CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed Central  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  55. Kernberg OF. Aggression in personality disorders and perversions. New Haven: Yale University Press; 1992.

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  58. Decety J, Jackson PL. The functional architecture of human empathy. Behav Cogn Neurosci Rev. 2004;3(2):71–100.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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  1. Department of Psychiatry, Harvard Medical School, Faculty, Boston Psychoanalytic Society and Institute, McLean Hospital, AOPC, Mailstop 115 Mill Street, Belmont, MA, 02478, USA

    Elsa Ronningstam

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This article is part of the Topical Collection on Personality and Impulse Control Disorders

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Ronningstam, E. Pathological Narcissism and Narcissistic Personality Disorder: Recent Research and Clinical Implications. Curr Behav Neurosci Rep 3, 34–42 (2016). https://doi.org/10.1007/s40473-016-0060-y

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