Clinical Characteristics of Comorbid Narcissistic Personality Disorder in Patients With Borderline Personality Disorder

Hörz-Sagstetter, Susanne; Diamond, Diana; Clarkin, John F.; Levy, Kenneth N.; Rentrop, Michael; Fischer-Kern, Melitta; Cain, Nicole M.; Doering, Stephan

doi:10.1521/pedi_2017_31_306

Cited by 17 publications

(12 citation statements)

References 49 publications

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“…We found many grandiose features that have been validated through empirical research [ 2 , 3 , 19 ]. Grandiosity, as reflected in the DSM-5, has been argued to be a key feature of pathological narcissism that distinguishes it from other disorders [ 26 , 28 ]. One feature regularly endorsed by participants that is not encompassed in DSM-5 criteria is relatives’ level of interpersonal charm and likability.…”

Section: Discussionmentioning

confidence: 99%

“…Recent research supports this defensive function of grandiosity, with Kaufman, Weiss [ 11 ] stating “ grandiose narcissism was less consistently and strongly related to psychopathology … and even showed positive correlations with adaptive coping, life satisfaction and image-distorting defense mechanisms ” (p. 18). Similarly, Hörz-Sagstetter, Diamond [ 28 ] state ‘high levels of grandiosity may have a stabilizing function’ on psychopathology (p. 569). This defence, however, comes at a high cost, whether it be to the self when the defensive grandiosity fails (triggering disintegrating bouts of vulnerability) or to others, as this style of relating exacts a high toll on those in interpersonal relationships [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…For instance, Euler, Stobi [27] found grandiose narcissism to be related to NPD, but vulnerable narcissism to be related to BPD. In a similar vein, Hörz-Sagstetter, Diamond [28] proposes grandiosity as a narcissistic 'specific' factor that distinguishes it from other disorders (e.g. BPD).…”

Section: Introductionmentioning

confidence: 99%

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Living with pathological narcissism: a qualitative study

Day

Townsend

Grenyer

2020

bord personal disord emot dysregul

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Background: Research into the personality trait of narcissism have advanced further understanding of the pathological concomitants of grandiosity, vulnerability and interpersonal antagonism. Recent research has established some of the interpersonal impacts on others from being in a close relationship with someone having such traits of pathological narcissism, but no qualitative studies exist. Individuals with pathological narcissism express many of their difficulties of identity and emotion regulation within the context of significant interpersonal relationships thus studying these impacts on others is warranted. Method: We asked the relatives of people high in narcissistic traits (indexed by scoring above a cutoff on a narcissism screening measure) to describe their relationships (N = 436; current romantic partners [56.2%]; former romantic partners [19.7%]; family members [21.3%]). Participants were asked to describe their relative and their interactions with them. Verbatim responses were thematically analysed. Results: Participants described 'grandiosity' in their relative: requiring admiration, showing arrogance, entitlement, envy, exploitativeness, grandiose fantasy, lack empathy, self-importance and interpersonal charm. Participants also described 'vulnerability' of the relative: contingent self-esteem, hypersensitivity and insecurity, affective instability, emptiness, rage, devaluation, hiding the self and victimhood. These grandiose and vulnerable characteristics were commonly reported together (69% of respondents). Participants also described perfectionistic (anankastic), vengeful (antisocial) and suspicious (paranoid) features. Instances of relatives childhood trauma, excessive religiosity and substance abuse were also described. Conclusions: These findings lend support to the importance of assessing the whole dimension of the narcissistic personality, as well as associated personality patterns. On the findings reported here, the vulnerable aspect of pathological narcissism impacts others in an insidious way given the core deficits of feelings of emptiness and affective instability. These findings have clinical implications for diagnosis and treatment in that the initial spectrum of complaints may be misdiagnosed unless the complete picture is understood. Living with a person with pathological narcissism can be marked by experiencing a person who shows large fluctuations in affect, oscillating attitudes and contradictory needs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Living with pathological narcissism: a qualitative study

Day

Townsend

Grenyer

2020

bord personal disord emot dysregul

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“…Those who are more pervasively angry (NV cold and NV intrusive) might be more akin to what Kernberg [58] refers to as having both narcissistic and borderline personalities, while those who withhold their anger (NV socially avoidant) might be more akin to the DSM-IV description of depressive personalities. Our present findings would explain the comorbidity that has historically been found between depressive and borderline personalities [59], narcissistic and borderline personalities [60, 58] and narcissistic and depressive personalities [11, 61]. Namely, it may be that evaluating more carefully the ways in which individuals experience and express their anger might be a better way to disentangle comorbidity.…”

Section: Discussionmentioning

confidence: 59%

Examining the Interpersonal Profiles and Nomological Network Associated with Narcissistic Grandiosity and Narcissistic Vulnerability

Cain¹,

Jowers²,

Blanchard³

et al. 2021

Psychopathology

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Theory and research have consistently shown that pathological narcissism can best be described by 2 phenotypic expressions, narcissistic grandiosity and narcissistic vulnerability. The current study sought to examine the specific types of interpersonal problems reported by those high in narcissistic grandiosity and high in narcissistic vulnerability as well as examine the nomological network associated with these 2 manifestations of narcissism. In a sample of university students who completed self-report measures of pathological narcissism, interpersonal problems, depression, self-esteem, malignant self-regard, self-defeating personality disorder symptoms, and anger, we found that narcissistic grandiosity (<i>n</i> = 108) was associated with one distinct interpersonal profile, for example, being overly intrusive in relationships with others, while narcissistic vulnerability (<i>n</i> = 88) was associated with a wider range of interpersonal problems on the interpersonal circumplex. Using cluster analysis, we found 3 interpersonal subtypes associated with narcissistic vulnerability, an intrusive subtype, a cold subtype, and a socially avoidant subtype. Further examination of group differences showed that the 3 interpersonal subtypes associated with narcissistic vulnerability could also be distinguished based on their experience and expression of anger. This suggests the importance of assessing profiles of interpersonal functioning and anger in narcissistic vulnerability. The clinical implications of our results are discussed.

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“…The case presented here was considered to have a poor prognosis on first evaluation because of the chronic multiple symptoms including pervasive preoccupation with suicidal ideation and failed previous treatment attempts. Positive prognostic indicators included the patient's high intelligence and level of education, good premorbid functioning in work, stable if somewhat limited intimate relationship, past accomplishments, which speak to her capacity for sublimation and investment in productive activity (Stone, ), and even her narcissistic features (e.g., organizing around grandiose fantasies) which can also be a stabilizing factor (see Diamond et al, ; Horz‐Sagstetter et al, ).…”

Section: Clinical Practices and Summarymentioning

confidence: 99%

Complex depression: The treatment of major depression and severe personality pathology

2019

Self Cite

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The intensive treatment of a patient presenting with major depression, chronic suicidal ideation, and a borderline personality disorder with narcissistic features is described as it developed over an 18-month treatment. The treatment approach is a transdiagnostic one with an emphasis on change in the patient's representation of self and others, identity and interpersonal functioning. The intended change is not only in the reduction of depression and suicidal ideation but also an improvement in interactions with others at work and intimate relations. The combination of rich clinical information from the therapist and independent research ratings of patient progress provide a complex picture of the treatment. K E Y W O R D S depression, individual psychotherapy, personality pathology, transference-focused psychotherapy How to cite this article: Clarkin JF, Petrini M, Diamond D. Complex depression: The treatment of major depression and severe personality pathology. J. Clin. Psychol. 2019;75:824-833. https://doi.

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Clinical Characteristics of Comorbid Narcissistic Personality Disorder in Patients With Borderline Personality Disorder

Cited by 17 publications

References 49 publications

Living with pathological narcissism: a qualitative study

Living with pathological narcissism: a qualitative study

Examining the Interpersonal Profiles and Nomological Network Associated with Narcissistic Grandiosity and Narcissistic Vulnerability

Complex depression: The treatment of major depression and severe personality pathology

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