Dear
Narcissist Problems,
Hello, I'm
needing some advice concerning my wife. After much reading and honest thought,
I believe she may be somewhere on the spectrum of NPD. I've been hit in the
face multiple times, hard (to which she says, "it was a slap, my hand was
opened")....well, I'm a 200# man, and my ears were ringing. She changes
into someone else when she's mad. After following her around the country for
her PhD (in psychology no less), supporting her all the way, only to have her
abandon her dissertation at the last minute, and blame me for her quitting.
Recently I believe that we've entered into the devaluation/discard phases. Over
the past two years, I've been working on being my best, and feel I've made big
improvements. 5 weeks ago, shortly after her getting a big raise, I noticed her
not needing me emotionally anymore. She's always been very attention needy, so
I knew something was wrong. I checked the phone records and discovered an
hour/day phone relationship with a lawyer "friend". It quickly became
her primary emotional relationship, and when confronted, she yelled at me for
things in the past, and showed anger, not remorse. She's stated repeatedly that
she "doesn't have much empathy", and that she "wants a man who
would go to the ends of the Earth for her"- which I do. After asking the
lawyer to stop talking with her, twice, with no reply, I threatened him with a
lawsuit and he cut it off. Now she's angry at me, stringing me along with
enough charm to get what she wants, and distant coldness, especially after
intimacy. I could go on....but I'm trying to figure out if she is indeed on the
spectrum of NPD or something else.
Thanks much,
Suddenly Slapped
Dear Slapped,
I would first like to say I do not hold a
degree in psychiatry the only thing I can do is give advice from experience and
help dig up some research. Before I get
into the research I would like to ask: “What in the hell are you doing with
this woman”? I see so many men stay in
abusive relationships and I really need to understand this more. I already understand why but are you
seriously thinking of sticking around to salvage this train wreck? It sounds to me like it doesn’t really matter
how far on the spectrum she is with any disorder she is abusing you physically
and financially. I was just participating in a conversation earlier in a group
for people who support men who are abused.
This man posted a picture of what his girlfriend did to him. I’m sure it started out with slaps but over
time this escalated to being stabbed with a fork and onto a butcher knife. He almost died! This woman has also confessed to you that she
has very little empathy, thank god she didn’t finish her dissertation in
psychology. My point is that this woman
is toxic and I have seen from experience what an aggressive woman with no
empathy is capable of. They are capable
of stabbing you, running you over with a car, and trying to smother you with a pillow
in your sleep. They will make your life
a living hell and then tell the police and the courts that YOU were the
aggressor. You stated that you are a 200
pound man and I’m sure as soon as she turns on the water works the authorities
will buy her story of self-defense. Get
away from her and make sure you document the crazy!
As for how far on the spectrum she is
According to the DSM-5 there are two criteria that must be filled to diagnose a
person with a personality disorder.
Criterion A is used to test an individual’s level of personality
functioning. This is further diagnosed
by assessing an individual’s pathological personality traits, Criterion B. So if you are looking for how far down the
spectrum your wife is you would want to ask how extreme her personality traits
are. It can be noted even by experts in the
field of psychiatry that “numerous potential inconsistencies in the
conceptualization of narcissism, including variants in describing its nature
(normal, pathological), phenotype (grandiosity, vulnerability), expression
(overt, covert), and structure (category, dimension, prototype). In all four of
these areas of conceptualization, DSM descriptions of the concept have been limited.” (Skodol,
Bender, & Morey 2014). It is also
noted in this article that there is very little research on narcissistic
personality disorder, its manifestations, and treatment available. As far as psychiatry is concerned the study
of this personality disorder is lacking.
This is why you will find so many of these support groups and pages
popping up all over the internet.
Victims of Narcissistic Abuse usually have no idea that they were abused
or they blame themselves for the abuse and rationalize it away. Moreover, the topic has such little research
into it that when we do go to therapy we are further invalidated in our
experiences.
So what does it take to be diagnosed with NPD?
Narcissistic
Personality Disorder (NPD) - The DSM Criteria
Narcissistic Personality Disorder (NPD) is listed in the
American Psychiatric Association’s Diagnostic & Statistical Manual (DSM) as
an Axis II, Cluster B (dramatic,
emotional, or erratic) Disorder:
A pervasive pattern of grandiosity (in fantasy or
behavior), need for admiration, and lack of empathy, beginning by early
adulthood and present in a variety of contexts, as indicated by five (or more)
of the following:
Has a grandiose sense of self-importance (e.g.,
exaggerates achievements and talents, expects to be recognized as superior
without commensurate achievements)
Is preoccupied with fantasies of unlimited success,
power, brilliance, beauty, or ideal love
Believes that he or she is "special" and unique
and can only be understood by, or should associate with, other special or
high-status people (or institutions)
Requires excessive admiration
Has a sense of entitlement, i.e., unreasonable
expectations of especially favorable treatment or automatic compliance with his
or her expectations
Is interpersonally exploitative, i.e., takes advantage of
others to achieve his or her own ends
Lacks empathy: is unwilling to recognize or identify with
the feelings and needs of others
Is often envious of others or believes that others are
envious of him or her shows arrogant, haughty behaviors or attitudes
I suggest visiting the above link.
There has been research springing up here and there that
recognizes the need to further explore this personality disorder and the
conclusion to a recent study was that “Conclusions: These findings suggest
that DSM-IV criteria for narcissistic personality disorder are too narrow,
underemphasizing aspects of personality and inner experience that are
empirically central to the disorder. The richer and more differentiated view of
narcissistic personality disorder suggested by this study may have treatment
implications and may help bridge the gap between empirically and clinically
derived concepts of the disorder.”(2008). This article goes on to say that “Despite
its severity and stability (1 , 2) , narcissistic personality disorder is one of the least
studied personality disorders.”
Attached is a useful study into the subject that will help you further
explore what could be going on.
Regards,
Narcissist Problems
By: Elsa Ronningstam
Harvard Medical School;
Pathological narcissism is characterized by fragility in
self-regulation, self-esteem and sense of agency, accompanied by strong
self-protective reactivity, emotion dysregulation, and a range of
self-enhancing and self-serving behaviors and attitudes. Areas or periods of
proactive and healthy narcissism coexist with pathological narcissism.
Self-regulatory fluctuations and accompanying shifts in self-esteem are context
dependent and affected by situational, that is, interpersonal or event
triggered reactivity. The phenotypic presentations of pathological narcissism
and NPD range from interpersonal pretentiousness, arrogance, and assertiveness,
to insecurity, shyness, and hypersensitivity (Cooper, 1998; Russ et al., 2008). Notable
is also that narcissistic individuals’ internal experiences may differ
significantly from their overt behavior and descriptive accounts. From an attachment
perspective narcissistic personality style and pathological narcissism are
suggested to be anchored in a detached-dismissing pattern (disliking attachment
to others and preferring investment in interpersonal space and own agency), or
in an avoidant pattern (defensive self-sufficiency). In addition, sensitive,
vulnerable narcissism has been associated with anxious or fearful preoccupied
attachment style (aspiring attachment but anticipating disappointment or
rejection; Fonagy, 2001; Dickinson & Pincus, 2003).
Grandiosity and accompanying self-enhancing and
self-serving incentives and behavior are part of a self-regulatory spectrum of
narcissistic personality functioning. Overt as well as covert signs of both
grandiosity and vulnerability coexist and affect narcissistic personality
functioning in each situation (Pincus & Lukowitsky, 2010).
Sense of competence, control, standards, and achievements are crucial for
self-evaluation and self-esteem (Zeigler-Hill, Myers, & Clark, 2010).
Self-agency conceptualizes the subjective awareness and
ownership of goal setting, and planning, initiating, executing, and controlling
one’s own thoughts, intentions, actions, and accomplishments (Fonagy, Gergely, Jurist, & Target,
2002; Gallagher, 2006; Knox, 2011). It signifies
implicit as well as explicit initiation, mastery, and self-direction, and it is
a fundamental part of self-regulation and self-esteem. As such self-agency is a
potential base for evaluating self-esteem regulation including grandiosity and
inferiority. In social-psychological studies of narcissism, self-agency has
been introduced to conceptualize narcissistic interpersonal and self-regulatory
strategies, such as attention seeking, competitiveness, and
self-esteem-enhancing relationships (Foster & Brennan, 2011).
Psychoanalytic studies noted that the subjective
experiences of fluctuating or loss of self-agency are especially consequential
for people whose sense of self-worth is fragile and whose ability for
interpersonal relatedness is compromised (Knox, 2011). Disturbance in
self-agency is an essential part of psychopathology (Spengler, von Cramon, & Brass,
2009; Fonagy et al., 2010). For
example, schizotypal traits correlate with deficits in prediction which lead to
weaker sense of self-agency (Asai & Tanno, 2008; Asai, Sugimori, & Tanno, 2008).
Discrepancies between predicted and actual action–effect connection contributed
to decreased sense of agency (Sato & Yasuda, 2005; Spengler, von Cramon, & Brass,
2009), and perceived reduced control of events was associated with
decreased experience of authorship/instigation (Aarts, Wegner, & Dijksterjuis,
2006).
A young man, Bob 21 years old, dropped out of college and
was hospitalized with a range of problems: At the initial evaluation the
clinician noticed general anxiety, obsessive–compulsive preoccupation, racing
thoughts, social anxiety, avoidance, and suicidality. Family members and
friends portrayed Bob to the case-manager as inconsiderate, demanding, and
demeaning, with threatening and verbally aggressive behavior, and involved in
poly substance abuse. Bob described himself as struggling with internal agony
caused by his inconsistent cognitive intellectual functioning, and feeling
overwhelmed by insecurity and internal self-criticism. He often felt frustrated
with other people; he found them stupid, unpredictable, and difficult to
understand. In addition, he had been isolating and engaged in Internet
sex-dating where he felt safer and more in control compared with if he tried to
meet somebody at bars and parties.
Bob also described the week before being hospitalized; on
Friday he met with his professor and began outlining a project for a paper. He
thought the meeting went well as he perceived that his ideas were well
understood and appreciated by his professor, and he left feeling motivated and
competent. On Sunday he spoke in front of 10,000 people at a big sports event
at his college. Apparently he did a good job, both according to his own
assessment and based on the others’ enthusiastic feedback. With a smile he
admitted that he felt he could become a future president of the United States.
On Tuesday he found himself unable to speak in front of his class of 8 peer
students. It was his turn to present the outline of his project, and just
before the class began he experienced sudden anxiety with difficulties holding
on to logical thinking and reasoning. When he was about to begin he experienced
a total cognitive blockage and had to leave the room. A day later he saw no
future for himself and struggled with excruciating self-reproach and intense
suicidal ideations and impulses. He admitted that he anticipated critical and
“stupid” comments from his peers and feared the anticipation of exposing
himself to something he could not control. Most of all, he felt unable to rely
upon his own competence and dreaded a sudden loss of his ability to think and
speak.
Bob was highly intelligent, with an IQ in the range
between 140 and 150. Some even considered him to be a genius, although he
himself did not believe that, but he appreciated the admiration and
acknowledgment. He was a competitive swimmer and leader of his swim team, and
had encountered no problems with either swimming or team leadership. He had
overall done well in college, especially on exams, and received high grades
despite some inconsistencies. His professional aspirations and plan was to
become a lawyer like his grand-father. He met 8 of the 9 Diagnostic and
Statistical Manual of Mental Disorders, fourth edition (DSM–IV) and
fifth edition (DSM-5) criteria for NPD (not #6, interpersonal
exploitive) according to the Diagnostic Interview for DSM–IV Personality
Disorders, DIPD-IV (Zanarini, Frankenburg, Sickel, & Young, 1996).
After having presented this rather diverse set of
experiences Bob said to the therapist: “I cannot trust my faculties, I do not
know from one day to another whether I can rely on my thinking and reasoning,
access my knowledge, communicate, and perform. I struggle inside myself with
dreadful self-scolding, constantly comparing and criticizing myself. I am a
perfectionist, and I know that I can be very good, even exceptional. I have
been considered a genius, but it does not hold up. I can’t tolerate closer
contact with people. I get so angry and frustrated at them. I can see that I
may be unfair, at times . . . , but I just can’t stand it. It works much better
when I am in charge or if there is a distance to other people, like if I have a
large audience. I feel extremely afraid of the future and ashamed of having to
be in treatment. Some days I really doubt that anything can change or that I
can get help, other days I can feel more optimistic”.
Bob presented with areas and moments of real potentials,
consistent competence, and proactive interpersonal functioning, that is, as a
swimmer and team leader, and in individual academic performance and
interactions with his supervisors. On the exceptional side was his ability to
speak in front of large audiences. He had both unrealistic grandiose fantasies
as well as real age-appropriate professional aspirations. He came across as
confident and self-promoting, alternating between bragging and a disdainful
attitude. However, internally he struggled with extreme self-criticism,
self-doubt (the reverse side of perfectionism), and interpersonal insecurity
when facing close and intimate or collaborative interactions with peers, as if
they tend to become critical enemies. However, this most consequential
vulnerability was not triggered in his physical sport activities, only in his
intellectual academic activities. In terms of self-agency, Bob was unable to
integrate and regulate perceptions of challenges, failures, and interpersonal
limitations with his actual competence and real abilities. From a
self-regulatory perspective he used perfectionism and avoidance as well as
substances to enhance self-esteem, and sense of control and to modulate
self-criticism, fear, and anxiety. Apparently he had reached a point where he
faced a rapid and extreme downhill spiral. High ambitions, perfectionism, and
intermittent experiences of competence and even exceptional abilities under
certain circumstances, turned into escalating interpersonal intolerance and fear,
insecurity, distancing and avoidance, self-criticism and self-scolding, with
substance usage and suicidality.
Although grandiosity is a diagnostic hallmark for NPD,
and an indication of the pathological grandiose self (Kernberg, 1975), its
complexity and changeability suggest that the diagnosis of NPD should not
depend heavily on overt indications of grandiosity (Ronningstam, Gunderson, & Lyons,
1995). State-dependent signs or temporary reactive increase of
grandiosity can alter or coexist with more persistent overt or covert grandiose
self-experience, as well as with more proactive or authentic functioning. Given
narcissistic patients’ identity diffusion and difficulties knowing who they
are, identifying and differentiating their real competence, assets, and
accomplishments from exaggerated or non-existing achievement and wished for
talents are important. Equally important is the differentiation of their age
appropriate ambitions and proactive aspiration from high-flying or unrealistic
fantasies. It is not uncommon that patients with NPD struggle with uncertainty,
shame, excessive self-criticism, and insecurity related to their actual talents,
value and competence, parallel with an enhanced self-presentation, especially
if they are young. Like in the case of Bob, it is also important to acknowledge
areas of actual individual uniqueness and special talents or potentials as part
of the overall self-regulatory functioning. In addition, encouraging patients’
own narrative, especially describing moments when they experience incompetence,
inferiority, and fragility, is also a most essential part of the diagnostic
process. The shifts in self-esteem from grandeur to inferior or vice versa with
accompanying self-regulatory change in self-enhancement and self-devaluation
are most informative. The subjective experiences of those interpersonal or
situational conditions that cause such shifts are diagnostic hallmark for
pathological narcissism and NPD (Ronningstam, 2012a, 2013).
Diagnostic evaluation and treatment tend to mobilize
self-protection and control in people with narcissistic personality
functioning. Some can be extremely and effectively defensive, focusing on
details or seemingly relevant issues while avoiding more urgent or deeper and
challenging problems. Others can mobilize plasticity and adjustment, agreeing
and following along, and still others can get argumentative, aggressive, and
critical. Although on the surface intelligent and articulated, even with
moments of perspective-taking and reflection, these people also present with a
significant resistance or inability to deeply connect, attach, and change.
Doubts, shame and insecurity, confused self-identity, and self-criticism,
combined with a range of self-enhancing strategies, contribute to their
sometimes drastic self-regulatory interpersonal stands.
A conditional and limited alliance is unfolding, that can
seem collaborative and interactive with common language, and even with
processing of challenging inquiries and complex interpretations. However, the
patients’ motive for seeking help and experience of facing treatment may be
totally separated from acknowledging their problems and work toward changes or
modifications of problematic areas functioning. Their reputation of being
difficult to treat, or even untreatable, stems from a particularly complex and
constricting mental functioning. Clinical observation and empirical findings
indicate compromised functioning and impaired abilities behind the NPD
diagnostic traits that indeed underpin pathological narcissism and contribute
to the specific internal and interpersonal regulatory patterns. Awareness and
integration of these factors in the diagnostic process is crucial for gaining a
meaningful identification of the narcissistic patient.
The first set of such factors concerns the ability to
access, process, and identify emotions. Studies have shown that both defensive
and compromised emotional functioning influence self-regulation in people with
pathological narcissism or NPD (Model, 1975; Krystal, 1998). Avoidance
of emotions, especially fear of failure and humiliation, is considered a
motivating, self-regulatory strategy (Bélanger et al., 2012). Vigilance,
sensitivity, and reactivity to negative events and anticipation of humiliation
(Besser & Zeigler-Hill, 2010)
can coexist with emotion intolerance and difficulties processing feelings, in
particular fear and shame. Fear, recognized in both psychoanalytic and
empirical studies as essential in pathological narcissism, is also underlying
several management and avoidance strategies typical for narcissistic
personality functioning, such as competitiveness, perfectionism, risk-taking,
and procrastination (Ronningstam & Baskin-Sommers, 2013).
Shame also plays a significant role, especially in narcissistic interpersonal
relating, and can motivate avoidance as well as defensive, retaliatory anger to
regain agency and control (Tangney, 1995; Trumbull, 2003).
Compromised emotion recognition, that is, impaired
accuracy in recognizing facial emotional expressions in others, especially fear
and disgust (Marissen, Deen, & Franken, 2012),
weaken the narcissistic patient’s ability for interpersonal guidance and
information processing. Similarly, alexithymia, that is, the inability
to feel and identify own feelings, either because of unawareness or incapacity
to distinguish physical and affect states or because of lacking words for
emotions (Krystal, 1998) can also
impede on the ability to recognize emotions in others (Fan et al., 2011).
Studies of empathic deficits, another outstanding feature
of NPD, have raised the question whether motivation/self-regulation or actual
deficits, or both, contribute to compromised empathic ability. Impairment in
emotional empathic ability was found in patients diagnosed with NPD (Ritter et al., 2011).
Although their cognitive emphatic ability was intact and influenced by
motivation, their emotional empathic functioning was affected by compromised
ability for mirroring and responsiveness to the emotional states of others. On
the other hand, NPD patients’ failure to accurately recognize emotions in
others combined with overestimation of their own empathic ability indicates a
more general empathic deficit (Marissen, Deen, & Franken, 2012).
Emotion intolerance may also play a role in empathic ability as the person may
be able to notice feelings in others, as mentioned above, but the perception of
others’ feeling states can evoke overwhelming powerlessness, disgust, shame or
loss of internal control, and hence trigger strong aggressive reactions or
emotional or physical withdrawal (Ronningstam, 2009). In
addition, noticeable fluctuations in narcissistic patients’ empathic ability
may be influenced by self-regulation, with increased ability to empathize when
feeling confident and in control, and decreased ability when feeling exposed,
inferior or threatened.
The specific attachment pattern associated with
pathological narcissism and NPD, as mentioned above, contributes to a second
set of factors involving significant difficulties relating and connecting,
especially in ways that can promote change (Kernberg, 2007). NPD
patients often do not know who they are on a deeper level, and their identity
is influenced by more profound and persistent self-enhancing efforts.
Difficulties with dependency and mutuality and strong tendencies for avoidance
and control are also, like in the case of Bob’s choice of intimacy via Internet,
typical indicators of compromised interpersonal functioning (Kernberg, 1998).
Perfectionism is such an effort because it involves both exceptionally high or
inflexible (although inconsistent) ideals and standards of self or others, with
strong reactions, including aggression, harsh self-criticism, shame, fear, or
deceitfulness when self or others fail to measure up (Hewitt et al., 2008; Ronningstam, 2010). In
interpersonal and social situations perfectionism can be self-promoting to
enhance certain qualities, but it can also be self-protective and serve to hide
something non-perfect. On the other hand, self-prescribed perfectionism can
contribute to extremely unyielding self-criticism, like in the case of Bob,
with hypervigilance and automatic cognitive appraisal of interpersonal
situations as overly provocative or threatening. Especially, it contributes to
reluctance to acknowledge and being seen as imperfect, and hence, to seek help
for own distress and to integrate and benefit from treatment interventions.
Impaired ability for self-disclosure, self-silencing,
selective or noncommunicativeness, and inability to share feelings and thoughts
(Model, 1980; Besser, Flett, & Davis, 2003)
are all aspects of narcissistic pathology that contribute to diagnostic
challenges. Similarly, reversible perspective taking (Etchegoyen, 1999), the
tendency to smoothly adopt the therapist’s comments and interpretations and
seemingly internalize those given perspective without changing one’s own, and
without incorporating the therapeutic process to generate change in own
personality functioning, is yet another complicating defensive feature.
A third set of factors relates to the specific
psychological aspects of trauma that can reinforce pathological narcissistic
functioning. A narcissistic trauma is caused by a subjective experience of loss
of supportive or sustaining external life conditions, such as changes in
marriage/family, work and career, or financial situation, or loss of connection
to a good, supportive idealized other person, leading to a loss or distortion
of internal ideals and meaning. Sudden loss of a sense of control and
competence, like in the case of Bob, can also be traumatizing for people whose
self-esteem is strongly connected with performance and achievement. Such losses
cause an acute internal state that threatens the continuity, coherence,
stability, and wellbeing of the self (Maldonado, 2006).
Narcissistic self-protection aimed at organizing and understanding the
traumatic experience fail, and the sense of loss, rejection, and abandonment,
along with feelings of shame, fear, and worthlessness become overwhelming (Gerzi, 2005). A
narcissistic trauma is more subjective and self-esteem related, and involving
exposure and humiliation. Sometimes such trauma can even be entirely emotional
and internal, accompanied by compromised hope, sense of value, control,
meaning, and affiliation. This contrasts to more external obvious traumatic
experiences, such as physical attacks, abuse, accidents, and so forth.
Narcissistic trauma, like in Trauma Associated Narcissistic Symptoms, TANS (Simon, 2002) can be
intrinsic to the characterological vulnerability to disruption of
self-regulation, and loss of agency and self-esteem in NPD. On the other hand,
narcissistic traumas, experienced in young age, can also be deeply internalized
and subjectively organized in a narcissistic patient’s mind, contributing to an
armor-like, seemingly impenetrable narcissistic character functioning, with
denial, omnipotence, and organizing and protecting narcissistic fantasies,
covering split off shame and fear. These types of traumatic experiences may
easily be either misdiagnosed or bypassed in a diagnostic evaluation as they
often differ from standard psychiatric definitions of trauma involving abuse,
neglect, catastrophes, and so forth (Ronningstam, 2012b; Simon, 2002; Krystal, 1998) and can
remain effectively shielded. Facing the impact of external life events might
actually help some patients to begin to access and process such subjectively
internalized experiences.
This study has focused on identifying underpinnings and
self-regulatory patterns behind the diagnostic traits for NPD. A flexible,
exploratory, and collaborative diagnostic process is recommended that attends
to the patients’ internal experiences and motivations as well as to their
external and interpersonal functioning. The patients’ limitations and
compromised abilities, as well as their interpersonally provocative, although
sometimes quite elaborative self-regulatory and enhancing strategies should be
attended to in ways that are informative and meaningful for both the patient
and clinician. Identifying and differentiating healthy or protective aspects of
narcissistic patterns from those that are pathological and perpetuating is
important. Clarifying the threatening, injuring, or traumatic experiences and
situations that escalate narcissistic reactivity is equally essential.
Clinicians’ observations of the narcissistic patients’ functioning often do not
concur with the patients’ own experiences of themselves or formulations of
their problems. More detailed exploration of a recent event that caused
fluctuations in the patient’s self-esteem and agency can be a useful start.
Such exploration can provide the opportunity to clarify the patient’s internal
subjective perspective, needs, and motives for self-enhancement, experiences of
vulnerability and deflation, and the organizing and protective role of
narcissistic functioning, both internally in relation to self and in
relationship to others. A focus on these areas of functioning is in line with
the Workgroups proposal for personality functioning in DSM-5 Section
III, which includes identity (regulation of self and emotions), self-direction
(self-agency), empathy and intimacy (interpersonal relatedness). With regard to
the diagnosis of NPD, these changes represent significant improvement compared
with the entirely trait-based diagnosis. Encouraging self-assessment and the
patients’ own narratives of their performance, anticipations, aspirations, and
shifts in states, self-esteem, and emotions can begin to bridge the different
perspectives of the patient and the clinician, and help reaching a diagnostic
agreement and understanding of the patient’s functioning.
Aarts, H., Wegner, D. M., & Dijksterhuis, A. (2006).
On the feeling of doing: Dysphoria and the implicit modulation of authorship
ascription. Behaviour Research and Therapy, 44, 1621–1627.
doi:10.1016/j.brat.2005.12.004
Asai, T., Sugimori, E., & Tanno, Y. (2008).
Schizotypal personality traits and prediction of one’s own movements in motor
control: What causes an abnormal sense of agency?Consciousness and
Cognition: An International Journal, 17, 1131–1142.
doi:10.1016/j.concog.2008.04.004
Asai, T., & Tanno, Y. (2008). Highly schizotypal
students have a weaker sense of self-agency. Psychiatry and Clinical
Neurosciences, 62, 115–119. doi:10.1111/j.1440-1819.2007.01768.x
Bélanger, J. J., Lafreniere, M.-A. K., Vallerand, R. J.,
& Kruglanski, A. W. (2013). Driven by fear: The effect of success and
failure information on passionate individuals performance. Journal of
Personality and Social Psychology, 104, 180–195.
doi:10.1037/a0029585
Besser, A., Flett, G. L., & Davis, A. (2003).
Self-criticism, dependency, silencing the self, and loneliness: A test of a
mediational model. Personality and Individual Differences, 35,
1735–1752. doi:10.1016/S0191-8869(02)00403-8
Besser, A., & Zeigler-Hill, V. (2010). The influence
of pathological narcissism on emotional and motivational responses to negative
events: The roles of visibility and concern about humiliation. Journal of
Research in Personality, 44, 520–534. doi:10.1016/j.jrp.2010.06.006
Cooper, A. M. (1998). Further developments of the
diagnosis of narcissistic personality disorder. In E.Ronningstam (Ed.), Disorders
of narcissism: Diagnostic, clinical, and empirical implications (pp.
53–74). Washington, DC: American Psychiatric Press.
Dickinson, K. A., & Pincus, A. L. (2003).
Interpersonal analysis of grandiose and vulnerable narcissism. Journal of
Personality Disorders, 17, 188–207. doi:10.1521/pedi.17.3.188.22146
Etchegoyen, H. R. (1999). Fundamentals of
psychoanalytic technique. London, UK: Karnac Books.
Fan, Y., Wonneberger, C., Enzi, B., de Greek, M., Ulrich,
C., Tempelmann, C., . . .Northoff, G. (2011). The narcissistic self and its
psychological and neural correlates: An exploratory fMRI study. Psychological
Medicine, 41, 1641–1650.
Fonagy, P. (2001). Attachment theory and
psychoanalysis. New York, NY: Other Press.
Fonagy, P., Gergely, G., Jurist, E., & Target, M.
(2002). Affect regulation, mentalization and the development of the self.
New York, NY: Other Press.
Fonagy, P., Luyten, P., Bateman, A., Gergely, G.,
Strathearn, L., Target, M., & Allison, D. E. (2010). Attachment and
personality pathology. In J. F.Clarkin, P.Fonagy, & G. O.Gabbard (Eds.), Psychodynamic
psychotherapy for personality disorders: A clinical handbook (pp. 37–87).
Arlington, VA: American Psychiatric Publishing, Inc.
Foster, J. D., & Brennan, J. C. (2011). Narcissism,
the agency model, and approach-avoidance motivation. In W. K.Campbell and J.
D.Miller (Eds.), The handbook of narcissism and narcissistic personality
disorder: Theoretical approaches, empirical findings, and treatments (pp.
89–100). Hoboken, NJ: Wiley.
Gallagher, S.Self-agency and mental causality.
Paper presented at Philosophical issues in psychiatry: Natural kinds, mental
taxonomy and the nature of reality. University of Copenhagen, Denmark, May
25–26, 2006.
Gerzi, S. (2005). Trauma, narcissism and the two
attractors in trauma. The International Journal of Psychoanalysis, 86,
1033–1050. doi:10.1516/2TTK-G0TL-9DWL-UHWY
Hewitt, P. L., Habke, A. M., Lee-Baggley, D. L., Sherry,
S. B., & Flett, G. L. (2008). The impact of perfectionist self-presentation
on the cognitive, affective and physiological experience of a clinical
interview. Psychiatry: Interpersonal and Biological Processes, 71,
93–122.
Kernberg, O. F. (1975). Borderline conditions and
pathological narcissism. New York, NY: Jason Aronson, Inc.
Kernberg, O. F. (1998). Pathological narcissism and
narcissistic personality disorder: Theoretical background and diagnostic
classification. In E.Ronningstam (Ed.), Disorders of narcissism -
Diagnostic, clinical, and empirical implications (pp. 29–51). Washington,
DC: American Psychiatric Press.
Kernberg, O. F. (2007). The almost untreatable
narcissistic patient. Journal of the American Psychoanalytic Association,
55, 503–539. doi:10.1177/00030651070550020701
Knox, J. (2011). Self-agency in psychotherapy. New
York, NY: Norton.
Krystal, H. (1998). Affect regulation and narcissism:
Trauma, alexithymia and psychosomatic illness in narcissistic patients. In
E.Ronningstam (Ed.), Disorders of narcissism - Diagnostic, clinical and
empirical implications (pp. 299–325). Washington, DC: American Psychiatric
Press.
Maldonado, J. L. (2006). Vicissitudes in adult life
resulting from traumatic experiences in adolescence. The International
Journal of Psychoanalysis, 87, 1239–1257.
doi:10.1516/4VUN-32CV-BPW9-8QBF
Marissen, M. A. E., Deen, M. L., & Franken, A.
(2012). Disturbed emotion recognition in patients with narcissistic personality
disorder. Psychiatry Research, 198, 269–273.
doi:10.1016/j.psychres.2011.12.042
Modell, A. H. (1975). A narcissistic defence against
affects and the illusion of self-sufficiency. The International Journal of
Psychoanalysis, 56, 275–282.
Modell, A. H. (1980). Affects and their
non-communication. The International Journal of Psychoanalysis, 61,
259–267.
Pincus, A. L., & Lukowitsky, M. R. (2010).
Pathological narcissism and narcissistic personality disorder. Annual Review
of Clinical Psychology, 6, 421–446.
doi:10.1146/annurev.clinpsy.121208.131215
Ritter, K., Dziobek, I., Preiβler, S., Rüter, A., Vaer,
A., Fydrich, T., . . .Roepke, S. (2011). Lack of empathy in patients with
narcissistic personality disorder. Psychiatry Research, 187,
241–247. doi:10.1016/j.psychres.2010.09.013
Ronningstam, E. (2009). Narcissistic Personality
Disorder: Facing DSM-V. Psychiatric Annals, 39: 111–121.
doi:10.3928/00485713-20090301-09
Ronningstam, E. (2010). Narcissistic Personality Disorder
– A current review. Current Psychiatry Report, 12, 68–75.
doi:10.1007/s11920-009-0084-z
Ronningstam, E. (2012a). Alliance building and the
diagnosis of Narcissistic Personality Disorder. Journal of Clinical
Psychology, 68, 943–953. doi:10.1002/jclp.21898
Ronningstam, E. (2012b). Narcissistic trauma and
sudden suicide. Paper presented at American Psychoanalytic Association
Winter Meeting. New York, January 2012.
Ronningstam, E. (2013). Narcissistic Personality Disorder
- The diagnostic process. In T.Widiger (Ed.), Handbook of personality
disorders (pp. 527–548). Oxford, UK: Oxford University Press.
Ronningstam, E., & Baskin-Sommers, A. (2013). Fear
and decision-making in narcissistic personality disorder - a link between
psychoanalysis and neuroscience. Dialogues in Clinical Neuroscience, 15,
191–201.
Ronningstam, E., Gunderson, J., & Lyons, M. (1995).
Changes in pathological narcissism. The American Journal of Psychiatry, 152,
253–257.
Russ, E., Shedler, J., Bradley, R., & Westen, D.
(2008). Refining the construct of narcissistic personality disorder: Diagnostic
criteria and subtypes. The American Journal of Psychiatry, 165,
1473–1481. doi:10.1176/appi.ajp.2008.07030376
Sato, A., & Yasuda, A. (2005). Illusion of sense of
self-agency: Discrepancy between the predicted and actual sensory consequences
of actions modulates the sense of self-agency, but not the sense of
self-ownership. Cognition, 94, 241–255.
doi:10.1016/j.cognition.2004.04.003
Simon, R. I. (2002). Distinguishing trauma-associated
narcissistic symptoms from posttraumatic stress disorder: A diagnostic
challenge. Harvard Review of Psychiatry, 10, 28–36.
doi:10.1080/10673220216206
Spengler, S., von Cramon, D. Y., & Brass, M. (2009).
Was it me or was it you? How the sense of agency originates from ideomotor
learning revealed by fMRI. NeuroImage, 46, 290–298.
doi:10.1016/j.neuroimage.2009.01.047
Tangney, J. P. (1995). Shame and guilt in interpersonal
relations. In J. P.Tangney & K. W.Fischer (Eds.), Self-conscious
emotions: The psychology of shame, guilt, embarrassment and pride (pp.
114–139). New York, NY: Guilford Press.
Trumbull, D. (2003). Shame: An acute stress response to
interpersonal traumatization. Psychiatry: Interpersonal and Biological
Processes, 66, 53–64.
Zanarini, M. C., Frankenburg, F. R., Sickel, A. E., &
Yong, L. (1996). Diagnostic Interview for DSM–IV Personality Disorders
(DIP-IV). Boston, MA: Laboratory for the Study of Adult Development, McLean
Hospital and the Department of Psychiatry, Harvard Medical School.
Zeigler-Hill, V., Myers, E. M., & Clark, B. (2010).
Narcissism and self-esteem reactivity: The role of negative achievement events.
Journal of Research in Personality, 44, 285–292.
doi:10.1016/j.jrp.2010.02.005
This publication is protected by US and international
copyright laws and its content may not be copied without the copyright holders
express written permission except for the print or download capabilities of the
retrieval software used for access. This content is intended solely for the use
of the individual user.
Source: Personality
Disorders: Theory, Research, and Treatment. Vol. 5. (4), Oct, 2014 pp. 434-438)
Accession Number: 2014-42878-005
Digital Object Identifier: 10.1037/per0000034
Russ,
E., Shedler, J., Bradley, R., & Westen, D. (2008). Refining the Construct
of Narcissistic Personality Disorder: Diagnostic Criteria and Subtypes. American
Journal of Psychiatry AJP, 165(11), 1473-1481.
http://dx.doi.org/10.1176/appi.ajp.2008.07030376
Skodol, A. E., Bender, D. S., & Morey, L. C. (2014).
Narcissistic personality disorder in DSM-5. Personality Disorders: Theory,
Research, And Treatment, 5(4), 422-427. doi:10.1037/per0000023
