Narcissism Predicts Therapy Outcome in Psychosomatic Patients

Abstract

Narcissism can be seen along a continuum of adjustment with well-defended narcissism on the adjusted end, and poorly-defended narcissism on the maladjusted end. Poorly-defended narcissism is associated with negative emotions, and somatic preoccupations. The present study investigated whether aspects of poorly-defended narcissism can be changed during hospital treatment and if the change predicts therapy outcome. Data from 1442 psychosomatic in-patients (70% women, mean age 40.1 years) at admission and discharge were analyzed. Narcissism, mood and quality of life were assessed with standardized instruments. Patients with somatoform, anxiety, depressive or adjustment disorders differed significantly in narcissistic aspects. During inpatient treatment, narcissistic aspects decreased, and mood and quality of life increased. Changes in threatened self were associated with an improvement on all mood dimensions. Psychosomatic hospital treatment can help patients with poorly-defended narcissism to regulate aspects of threatened self with subsequent positive impact on mood and quality of life.

Development and Factorial Validation of a Short Version of the Narcissism Inventory (NI-20)

“…Furthermore, narcissism is a distinct aspect in patients which might enhance psychosomatic complaints as well as impede psychotherapeutic outcome [20] . In this paper, we present the empirical development of a short version of the NI-90, the NI-20.…”

“…Studies show that overt narcissism is more related with psychological wellbeing [16] , whereas covert narcissism is related with a lack of self-confidence, negative emotionality, ineffective emotion regulation, and feelings of inferiority [5,8,[17][18][19] . The latter aspects can be attributed to the concept of threatened self [20] .…”

The Impact of Pathological Narcissism on Psychotherapy Utilization, Initial Symptom Severity, and Early-Treatment Symptom Change: A Naturalistic Investigation

“…With regard to the outcome of completed psychotherapy, Daig, Klapp, and Fliege (2009) found that scores on the "threatened self" index of the Narcissism Inventory-90 (Schoeneich et al, 2000), a German measure, predicted change in a sample of inpatients offered psychodynamic therapy for psychosomatic complaints (a plurality had a diagnosis of somatoform disorder). Specifically, individuals with higher "threatened self" scores had higher anger and anxious-depressed mood scores at discharge, as well as lower levels of social functioning and mental health, in cross-lagged regression models.…”

Do Patients with Somatoform Disorders Present with Illusory Mental Health?

“…Studies have shown the inventory to be both reliable and valid [33]. Moreover the temporal stability of the instrument is high, rendering it appropriate for structural personality assessment [28]. In the DSFM profile interpretation, raw scores are compared with normative data for psychiatric patients.…”

“…Self-reported personality traits did not predict treatment outcome beyond initial symptoms in a sample of psychosomatic inpatients in one study [26], but did in another [27]. Narcissistic characteristics were found to be prospective for therapy outcome in SFD-patients [28]. Based on these considerations, it seems interesting to investigate the role of structural personality characteristics that needs to be distinguished from the purely descriptive classification approach of DSM-IV.…”