Narcissistic Personality Disorder as an Intrapsychic Trajectory to Real Self-Love: A Case Report

The intrapsychic mechanism of remission in a forensic psychiatric patient with narcissistic personality disorder and comorbid antisocial features is examined. The positive impact of a therapeutic and academic program on the patient’s development and recovery and correlated increase of true self-love is analyzed and discussed. Real self-love appeared to be associated with stable selfesteem and enhancement of self-insight, authenticity, and reality testing capacities.     

God Diagnosed with Narcissistic Personality Disorder

This article endorses the contention that God suffers from a mental disorder, but challenges J. Henry Jurgens’ diagnosis of bipolar disorder as reported in The Onion (“God diagnosed with bipolar disorder”, 2001) and proposes narcissistic personality disorder instead. It uses the diagnostic criteria for narcissistic personality disorder from The Diagnostic and Statistical Manual of Mental Disorders—DSM-IV (American Psychiatric Association, Washington, DC, 1994) and various biblical citations in support of this diagnosis. It rejects the idea that a major personality change is reflected in the New Testament and claims that God did not experience a major transformation of his narcissistic personality structure as described by Heinz Kohut (Forms and transformations of narcissism, in A. P. Morrison, Ed., Essential papers on narcissism, pp. 61–87, New York University Press, New York, 1966/1986). However, it concludes that God’s creativity accounts for the stability of his narcissistic personality structure and helps to explain his lack of empathy toward human beings.

John W. Hinckley, Jr.: A Case of Narcissistic Personality Disorder

This article is about John W. Hinckley, Jr., whose attempt to assassinate President Ronald Reagan on March 30, 1981 was unsuccessful and whose trial in 1982 resulted in a verdict of not guilty by reason of insanity. It focuses on the view of psychiatric experts that he has a narcissistic personality disorder and on the fact that this diagnosis is the primary rationale for his continuing confinement to St. Elizabeth’s Hospital in Washington, D.C. I conclude that the question of his release raises the difficult issue of the possible conflict between justice and care.     

Adopting Metacognitive Interpersonal Therapy to Treat Narcissistic Personality Disorder with Somatization

Narcissistic personality disorder (NPD) is characterized by an intellectualizing narrative style, poor metacognition, maladaptive interpersonal schemas, a restricted set of states of mind, impaired agency and perfectionism. Metacognitive Interpersonal therapy targets these dysfunctions with a series of formalized procedures aimed at first forming a shared formulation of functioning which patients and therapists can then use to plan change. We describe here the core NPD pathology and illustrate the therapy process of a patient with NPD and a somatization disorder. Implications for treatment of NPD are discussed together with a call for empirical testing of therapies for this severe condition.     

Recommending Interventions for a Borderline Personality Disorder Patient

Borderline personality disorder (BPD) is a severe personality disorder leading to unstable emotional state, impulsivity, disturbed relationships and personal distress. This paper suggests a 12-step intervention plan including Dialectical Behavior Therapy (DBT) to Mr. X, a 21 year old male psychiatric inpatient having BPD, to promote his mental health. Therapy could not be conducted as the patient dropped out of treatment and got himself discharged from the hospital. This paper outlines implications for treatment on the basis of the clinical presentation of Mr. X. Mr. X presents himself with the BPD features showing suicidal tendencies, substance abuse and disturbed emotions. In depth interview of the patient showed extreme emotional disturbance and difficulty in controlling emotions and suicidal ideations. He was admitted at the Nur Manzil Psychiatric Centre, Lucknow, India and was kept under close observation because of being obsessed with suicidal thoughts; he also tried to kill himself. The DBT skills training and problem solving approach along with contingency management and behavioral chain analysis are suggested according to the clinical profile of Mr. X in order to reduce his self mutilating acts and substance abuse. Thus a general feeling of personal well being can be achieved thereby reducing personal distress.     

Age-Related Personality Differences in Inpatients with Personality Disorder: A Cross-Sectional Study

There are few empirical studies of age-associated differences in personality characteristics of individuals diagnosed with Personality Disorder (PD), and none that comparatively examine multiple personality characteristics, with a variety of psychological measures, across a wide age range in adults diagnosed with PD and coexisting substance abuse. Personality test data of 392 psychiatric inpatients diagnosed with PD were analyzed by age group. Patients were assessed with the California Psychological Inventory, Psychological Inventory of Personality and Symptoms, Diagnostic Inventory of Personality and Symptoms, Minnesota Multiphasic Personality Inventory-1, and the Millon Clinical Multiaxial Inventory-1. There were no age differences in the number of patients diagnosed with PD, but older adults were significantly less likely to be diagnosed with more than one PD. Older patients with PD were significantly less impulsive, paranoid, high-energy, antisocial, and irresponsible than younger patients with PD. It appears that, with aging, there is a general mellowing of personality for those diagnosed with PD, which may be related to the proposed geriatric variants of PD.     

Metacognitive Interpersonal Therapy Improves Adherence to Antiretroviral Therapies in a Man with a Severe Personality Disorder: A Case Report

Treatment adherence by patients with HIV ensures they gain the full benefit of antiretroviral medications and extend their lives. One problem which may contribute to poor adherence is deficits in metacognition or the capacity to make sense of mental states. In particular, persons who struggle to notice and think about their thoughts and feelings may be less able to direct their own recovery by taking advantage of effective treatments. This raises the possibility that treatments which lead to improved metacognitive function may enhance treatment adherence. We describe the case of a man in an advanced stage of AIDS with Kaposi’s sarcoma. The patient was treated with Metacognitive Interpersonal Therapy combined with psychoeducation about pharmacological treatment for HIV. Primary medical outcomes were suppression of viral load, increase of CD4 count and control of AIDS related conditions such as Kaposi’s sarcoma. The primary psychological outcome was reduction of personality disorders criteria. The patient was able to understand what led him to discontinue medication and then later regain full adherence. He achieved suppression of viral load and restore of CD4 count. As regard severity of personality disorder, he achieved reliable change. Interventions such as Metacognitive Interpersonal Therapy may assist patients with HIV to gain the metacognitive capacities to make sense of their medical and psychological challenges and adhere to antiretroviral therapies leading to enhanced levels of health. Future studies are needed to explore these findings in larger controlled studies.     

Behavioral Activation for a Breast Cancer Patient with Major Depression and Coexistent Personality Disorder

Behavioral activation is an empirically validated treatment for depression, with recent applications toward other psychological and medical conditions. However, modification to the treatment protocol may be necessary when symptoms, environment, or personality necessitate. This feasibility study applied Behavioral Activation Treatment for Depression (BATD) in a case of a woman with recurrent major depression and obsessive–compulsive personality disorder (OCPD) undergoing breast cancer treatment. A quasi-experimental design was used, comparing supportive psychotherapy (while she received radiation therapy) followed by eight sessions of BATD. Treatment was designed in accordance with patient and therapist goals of increasing exercise, decreasing fatigue, and reducing interference due to perfectionistic behaviors. The patient exhibited resistance to initiation of BATD, related to symptoms of OCPD, which necessitated modification of treatment strategies and scheduling. Following BATD, the patient reported a significant reduction in depressive symptoms, physical problems, and role limitations—gains not observed following supportive therapy. In addition, she demonstrated less psychological rigidity and interference due to OCPD symptoms within the therapeutic relationship and other interpersonal relationships. Consistent with previous research, results indicate BATD may effectively treat individuals with complex clinical presentations that include personality disorder pathology. In addition, methods of modification to BATD are discussed, as well as future directions for research in this area.     

The Treatment of Histrionic and Narcissistic Personality Disorder Behaviors: A Single-Subject Demonstration of Clinical Improvement Using Functional Analytic Psychotherapy

This article presents single-subject data for the treatment of histrionic and narcissistic personality disorder behaviors using a relatively brief course of an interpersonal therapy, Functional Analytic Psychotherapy (Kohlenberg & Tsai, 1991). The treatment produced significant changes in these behaviors both statistically and qualitatively. Empirical methods for analyzing the changes across sessions and for determining that the therapist engaged in the proposed mechanism of clinical change are discussed. While these data are for one subject, the results of treatment provide both a method of treating difficult and long-standing client behaviors such as these, and for assessing the progress of therapy.     

Personality in Panic Disorder With Agoraphobia: A Rorschach Study

In this study, we tested several hypotheses derived from self psychology (Diamond, 1987) regarding personality features of patients suffering from panic disorder and agoraphobia (PDA). PDA patients are thought to suffer from a deficit in negative affect-regulating capacity, surrounded by defenses such as avoidance, repression, denial, and reaction formation against dependency needs. These defenses are thought to lead to a greatly impoverished affective life. The Rorschach Comprehensive System was used to assess the personality features of avoidance, restricted affective life, and reaction formation against dependency needs. We found evidence for the presence of a highly avoidant information-processing style (86% of protocols had lambda [L] > .99) and a constricted affective life (low weighted sum color [WSumC] and low affective ratio [Afr]). Our results were consistent with the hypothesis of reaction formation against dependency needs (low food content [Fd]). Findings are discussed in light of studies that found a high incidence of avoidant personality disorder in PDA patients.     

Diagnosis of Personality Disorders: A Case Study

In this article, I report a case highlighting diagnostic uncertainty about psychopathology on both Axes I and II. It concerns in part the problem of comorbidity in relation to diagnostic classification of Axis II personality disorders. After commenting on these uncertainties in relation to categorical and dimensional models, I also consider a psychoanalytic explanation to illustrate an example in which a theoretical model informs diagnostic interviewing. I emphasize how the clinical information that unfolds from an interview based on this theoretical model generates inferences about psychopathology that extend clinical understanding beyond the formal diagnostic assessment of Axes I and II disorders and assessment by self-report.     

Using Symbolic-Experiential Family Therapy to Treat Adjustment Disorder: A Case Study

Despite studies claiming Adjustment Disorders (AD) affect up to 10% of the general population, research is severely lacking for effective treatment recommendations and screening tools. This article presents the treatment of a 30-year old Caucasian male diagnosed with AD - mixed anxiety and depression subtype. After 12 standard 60-minute sessions, treatment using a Symbolic-Experiential Family Therapy (SEFT) approach resulted in the alleviation of depression and anxiety symptoms. This case study provides preliminary evidence for the effectiveness of SEFT using a mixed methods case study. Implications for further study, and the usefulness of SEFT for the treatment of AD, is presented.