Narcissistic Personality Disorder with Borderline Features
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.
KeywordsDismissiveness Self-enhancement Aggression Alexithymia Emotion dysregulation Alliance-building Countertransference Non-judgmental inquiring Interpretation Confrontation Validation narcissistic personality disorder Pathological narcissism
- 3.Kernberg OF, Selzer MA, Koenigsberg HW, Carr AC, Appelabum AH. Psychodynamic psychotherapy of borderline patients. New York: Basic Books, Inc. Publishers; 1989. p. 104–5.Google Scholar
- 10.Van der Kolk B. The body keeps the score. Brain, mind and body in the healing of trauma. New York: Penguin Book; 2014.Google Scholar
- 11.Weinberg I, Ronningstam E. Examination of factors contributing to improvement in NPD patients in psychotherapy. 14th Congress of the International Society for Study of personality disorders; Montreal, Canada, October, 2015.Google Scholar