Narcissistic Personality Disorder with Borderline Features

  • Elsa Ronningstam


Patients with a primary narcissistic personality disorder with accompanying borderline features present with specific challenges in psychotherapy. Their initial provocations and dismissiveness can significantly mask their internal struggle. A neutral and validating therapeutic approach can help patients feeling seen and recognized, and invite their description and reflective ability of their subjective experiences. Exploration of emotional functioning and capability is important as emotional disengagement can represent both a self-enhancing defense strategy or a neuropsychological deficits in emotional processing. Attention to external life experiences outside of treatment is also important as they can contribute to corrective emotional experiences and realizations promoting change.


Dismissiveness Self-enhancement Aggression Alexithymia Emotion dysregulation Alliance-building Countertransference Non-judgmental inquiring Interpretation Confrontation Validation narcissistic personality disorder Pathological narcissism 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Elsa Ronningstam
    • 1
  1. 1.Harvard Medical School, Department of PsychiatryMcLean HospitalBelmontUSA

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