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.

Inpatient Therapeutic Assessment With Narcissistic Personality Disorder

Growing evidence supporting the effectiveness of Collaborative/Therapeutic Assessment (C/TA) has led clinicians and researchers to apply C/TA to a variety of clinical populations and treatment settings. This case example presents a C/TA inpatient adaptation illustrated with narcissistic personality disorder. After a brief overview of salient concepts, I provide a detailed account of the clinical interview, test interpretation paired with diagnostic considerations specific to narcissism, planned intervention, and discussion of assessment results. Throughout the case study, I attempt to demonstrate defining features of C/TA, inpatient adaptations, and clinical techniques that encourage meaningful engagement with a “hard to reach” personality.     

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.     

Transference Focused Psychotherapy for Patients with Comorbid Narcissistic and Borderline Personality Disorder

Clinical experience involving the treatment of patients with comorbid borderline and narcissistic personality disorders suggests that this patient population is among the more difficult to treat within the personality disorder spectrum. In this article, we present refinements of Transference Focused Psychotherapy (TFP) based on our clinical experience with and research data on patients with comorbid narcissistic personality disorder/borderline personality disorder (NPD/BPD). We briefly review object relations formulations of severe narcissistic pathology, as well as recent research in attachment and the allied concept of mentalization, which have provided a new lens through which to view narcissistic disorders. The research findings from two randomized clinical trials demonstrating the efficacy and effectiveness of TFP are presented. The data from the two Randomized Clinical Trials (RCT) allowed for the study of the characteristics of the subgroup of borderline personality disorder patients who have comorbid NPD/BPD. Findings on comorbidity, attachment status, capacity for mentalization, and level of personality organization of borderline patients with comorbid NPD/BPD, compared with borderline patients without comorbid narcissistic pathology (BPD), are presented. Clinical implications of the observed group differences are discussed, with a focus on refinements in the technique of TFP. Clinical case material is presented to illustrate the specific challenges posed by narcissistic patients to carrying out TFP in each phase of treatment.     

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.     

The Factor Structure of the Narcissistic Personality Inventory

Seventy-seven female and 86 male psychologist practitioners filled out the Bem Sex Rote Inventory to describe either a healthy adult male, healthy adult female, or healthy adult, sex unspecified. Analyzing the data according to Bem's classification of masculinity, femininity, and androgyny produced a significant Scale X Condition interaction with male and female practitioners ascribing significantly more masculine than feminine traits to healthy adult men, yet displaying no comparable differences when rating healthy adult women. Analyzing the data according to Spence's classification of masculine, feminine, androgynous, and undifferentiated produced a Group X Condition interaction with practitioners ascribing significantly more masculine traits to healthy adult men and significantly more feminine traits to healthy adult women. Reanalyses omitting "masculine" and "feminine" from Bem's fist of sex-typed traits produced nonsignificant results. The relationship of this to recent criticisms of the construct validity of the BSRI and to the validity of earlier results of therapist sex-role bias was discussed.     

The factor structure of the Narcissistic Personality Inventory

In the first study, we administered the 40-item Narcissistic Personality Inventory (NPI; Raskin & Terry, 1988) to 843 female and 843 male college students, most of whom were Euro-American, to comprehensively assess the NPI factor structure using confirmatory factor analysis. Initial exploratory common factor analyses (N = 724) revealed a 2-factor model (Leadership/Authority and Exhibitionism/Entitlement). Subsequently, we used confirmatory factor analysis in a separate sample (N = 724) to evaluate the Emmons (1987) 4-factor model, the Raskin and Terry (1988) 7-factor model, the Kubarych, Deary, and Austin (2004) 2- and 3-factor models, and our 2-factor model. Finally, we assessed construct validity by correlating the scale scores with the Five-factor model of personality in an independent sample (N = 238). The 2-factor models for the NPI we obtained in this study and by Kubarych et al. (2004) appeared to be the most parsimonious models, with both a good fit to the data and satisfactory internal consistency values; so they are recommended for use. However, additional NPI research is needed to rescale, modify, or omit several NPI items and develop gender-equivalent items.     

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.     

Understanding and Treatment of Narcissistic Personality Disturbances

The author discusses how sexuality on the one hand develops and changes during childhood, but on the other hand, holds onto the old residues of different, earlier phases. In adult sexuality, there always remain enigmatic, regressive, even borderline emotions and feelings from earlier experiences. These residues make sexuality incomprehensible and primitive, but also offer possibilities for dreams, fantasies and creativity later in life. Autoerotic fantasies, object fantasies, enigmatic knowledge, sexuality fantasies and creative thinking are realised via these developmental residues.     

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.     

Etiology of the Masochistic and Narcissistic Personality

The American Journal of Psychoanalysis -     

East of Ego: The Intersection of Narcissistic Personality and Buddhist Practice

This article explores the intersection of clinical narcissism and Buddhist meditation practice. Through the lens of Otto Kernberg and Heinz Kohut’s theories of narcissism, the article investigates the many facets of Eastern spiritual practice when undertaken by a narcissistic practitioner. In particular, questions are raised regarding the potential psychological dangers of pursuing meditation practice when suffering from clinical narcissism. Potential applications for a cross-pollination of psychoanalytic support and Buddhist practice are also considered for the narcissistic patient and/or spiritual practitioner.     

The Developmental Roots of Borderline Personality Disorder in Early Attachment Relationships: A Theory and Some Evidence

The paper suggests a way of understanding borderline personality disorder in terms of the failure of a secure base. We begin with an account of optimal self-development in a secure attachment context, highlighting the importance of the caregiver's ability to help the small child think about his own and others' minds. This optimal self-development is crucial in developing the child's capacity for mentalization, which can enhance his resilience in the face of later trauma. We discuss the impact of attachment trauma in later development, arguing that the extent of this impact depends on how well early attachment relationships facilitated the capacity for mentalization. We identify some of the consequences for the representations of the internal world of a failure of mentalization that may follow trauma in individuals made vulnerable by genetic predisposition or disorganized early attachment. We link these features to the clinical presentation associated with borderline personality organization. Finally, some of the necessary characteristics of successful psychotherapeutic treatment of borderline personality disorder are briefly considered.