Living with pathological narcissism: a qualitative study
Tóm tắt
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. We asked the relatives of people high in narcissistic traits (indexed by scoring above a cut-off 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. 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. 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.
Tài liệu tham khảo
American Psychiatric Association. Diagnostic and statistical manual of mental disorders 5th ed. Arlington: Author; 2013.
Miller JD, Hoffman BJ, Campbell KW, Pilkonis PA. An examination of the factor structure of diagnostic and statistical manual of mental disorders, fourth edition, narcissistic personality disorder criteria: one or two factors? Compr Psychiatry. 2008;49(2):141–5. https://doi.org/10.1016/j.comppsych.2007.08.012.
Cain NM, Pincus AL, Ansell EB. Narcissism at the crossroads: phenotypic description of pathological narcissism across clinical theory, social/personality psychology, and psychiatric diagnosis. Clin Psychol Rev. 2008;28(4):638–56. https://doi.org/10.1016/j.cpr.2007.09.006.
King RM, Grenyer BFS, Gurtman CG, Younan R. A clinician’s quick guide to evidence-based approaches: narcissistic personality disorder. Clin Psychol. 2020;24(1):91–5. https://doi.org/10.1111/cp.12214.
Skodol A, Bender DS, Morey LC. Narcissistic personality disorder in DSM-5. Personal Disord Theory Res Treat. 2014;5(4):422–7. https://doi.org/10.1037/per0000023.
Pincus AL, Lukowitsky MR. Pathological narcissism and narcissistic personality disorder. Annu Rev Clin Psychol. 2010;6:421–46. https://doi.org/10.1146/annurev.clinpsy.121208.131215.
Pincus AL, Cain NM, Wright AG. Narcissistic grandiosity and narcissistic vulnerability in psychotherapy. Personal Disord Theory Res Treat. 2014;5(4):439–43. https://doi.org/10.1037/per0000031.
Russ E, Shedler J. Defining narcissistic subtypes. In: Ogrodniczuk JS, editor. Understanding and Treating Pathological Narcissism: American Psychological Association; 2013. p. 29–43.
Levy KN. Subtypes, dimensions, levels, and mental states in narcissism and narcissistic personality disorder. J Clin Psychol In Session. 2012;68(8):886–97. https://doi.org/10.1002/jclp.21893.
Yakeley J. Current understanding of narcissism and narcissistic personality disorder. BJPsych Advances. 2018;24(05):305–15. https://doi.org/10.1192/bja.2018.20.
Kaufman SB, Weiss B, Miller JD, Campbell WK. Clinical Correlates of Vulnerable and Grandiose Narcissism: A Personality Perspective. J Pers Disord. 2020;34(1):107–30. https://doi.org/10.1521/pedi_2018_32_384.
De Panfilis C, Antonucci C, Meehan KB, Cain N, Soliani A, Marchesi C, et al. Facial emotion recognition and social-cognitive correlates of narcissistic features. J Pers Disord. 2018. https://doi.org/10.1521/pedi_2018_32_350.
Pincus AL, Ansell EB, Pimentel CA, Cain NM, Wright AG, Levy KN. Initial construction and validation of the pathological narcissism inventory. Psychol Assess. 2009;21(3):365–79. https://doi.org/10.1037/a0016530.
Dimaggio G, Semerari A, Falcone M, Nicolò G, Carcione A, Procacci M. Metacognition, states of mind, cognitive biases, and interpersonal cycles: proposal for an integrated narcissism model. J Psychother Integr. 2002;12(4):421–51. https://doi.org/10.1037/1053-0479.12.4.421.
Winnicott DW. The maturational processes and the facilitating environment: studies in the theory of emotional development. New York: International University Press Inc; 1960. p. 1–182.
OF K. Aggressivity, narcissism, and self-destructiveness in the psychotherapeutic relationship: new developments in the psychopathology and psychotherapy of severe personality disorders. New Haven: Yale Univerity Press; 2008.
Krizan Z, Johar O. Narcissistic rage revisited. J Pers Soc Psychol. 2015;108(5):784–801. https://doi.org/10.1037/pspp0000013.
Ronningstam E. Narcissistic personality disorder in DSM-V—in support of retaining a significant diagnosis. J Pers Disord. 2011;25(2):248–59. https://doi.org/10.1521/pedi.2011.25.2.248.
Ronningstam E. Narcissistic personality disorder: facing DSM-V. Psychiatric Annals. 2009;39(3). https://doi.org/10.3928/00485713-20090301-09.
Giacomin M, Jordan CH. Down-regulating narcissistic tendencies: communal focus reduces state narcissism. Personal Soc Psychol Bull. 2013;40(4):488–500. https://doi.org/10.1177/0146167213516635.
Giacomin M, Jordan CH. The wax and wane of narcissism: grandiose narcissism as a process or state. J Pers. 2016;84(2):154–64. https://doi.org/10.1111/jopy.12148.
Jauk E, Weigle E, Lehmann K, Benedek M, Neubauer AC. The relationship between grandiose and vulnerable (hypersensitive) narcissism. Front Psychol. 2017;8:1600. https://doi.org/10.3389/fpsyg.2017.01600.
Lingiardi V, McWilliams N. Psychodynamic diagnostic manual (PDM-2). 2nd ed. New York: The Guilford Press; 2017.
McWilliams N. Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process. 2nd ed. New York: The Guilford Press; 2011.
Caligor E, Stern BL. Diagnosis, classification, and assessment of narcissistic personality disorder within the framework of object relations theory. J Personal Disord. 2020;34:104–21. https://doi.org/10.1521/pedi.2020.34.supp.104.
Sharp C, Wright AG, Fowler JC, Frueh BC, Allen JG, Oldham J, et al. The structure of personality pathology: both general (‘g’) and specific (‘s’) factors? J Abnorm Psychol. 2015;124(2):387–98. https://doi.org/10.1037/abn0000033.
Euler S, Stobi D, Sowislo J, Ritzler F, Huber CG, Lang UE, et al. Grandiose and vulnerable narcissism in borderline personality disorder. Psychopathology. 2018;51(2):110–21. https://doi.org/10.1159/000486601.
Hörz-Sagstetter S, Diamond D, Clarkin J, Levy K, Rentrop M, Fischer-Kern M, et al. Clinical characteristics of comorbid narcissistic personality disorder in patients with borderline personality disorder. J Personal Disord. 2018;32(4):562–75. https://doi.org/10.1521/pedi_2017_31_306.
Ogrodniczuk JS, Kealy D. Interpersonal problems of narcissistic patients. In: Ogrodniczuk JS, editor. Understanding and Treating Pathological Narcissism: American Psychological Association; 2013. p. 113–27.
Byrne JS, O'Brien EJ. Interpersonal views of narcissism and authentic high self-esteem: it is not all about you. Psychol Rep. 2014;115(1):243–60. https://doi.org/10.2466/21.09.PR0.115c15z9.
Cheek J, Kealy D, Joyce AS, Ogrodniczuk JS. Interpersonal problems associated with narcissism among psychiatric outpatients: A replication study. Arch Psychiatry Psychotherapy. 2018;2:26–33. https://doi.org/10.12740/APP/90328.
Grenyer BFS. Historical overview of pathological narcissism. In: Ogrodniczuk JS, editor. Understanding and Treating Pathological Narcissism: American Psychological Association; 2013. p. 15–26.
Day NJS, Bourke ME, Townsend ML, Grenyer BFS. Pathological narcissism: A study of burden on partners and family. J Pers Disord. 2019;33(11). https://doi.org/10.1521/pedi_2019_33_413.
Bailey R, Grenyer BFS. Supporting a person with personality disorder: a study of carer burden and well-being. J Personal Disord. 2014;28(6):796–809. https://doi.org/10.1521/pedi_2014_28_136.
Green A, Charles K. Voicing the Victims of Narcissistic Partners: A Qualitative Analysis of Responses to Narcissistic Injury and Self-Esteem Regulation. SAGE Open. 2019;9(2). https://doi.org/10.1177/2158244019846693.
Oltmanns JR, Crego C, Widiger TA. Informant assessment: the informant five-factor narcissism inventory. Psychol Assess. 2018;30(1):31–42. https://doi.org/10.1037/pas0000487.
Klonsky ED, Oltmanns TF. Informant-reports of personality disorder: relation to self-reports and future research directions. Clin Psychol Sci Pract. 2002;9(3):300–11. https://doi.org/10.1093/clipsy.9.3.300.
Lukowitsky MR, Pincus AL. Interpersonal perception of pathological narcissism: a social relations analysis. J Pers Assess. 2013;95(3):261–73. https://doi.org/10.1080/00223891.2013.765881.
Gottschalk LA, Winget CN, Gleser GC. Manual of instruction for using the Gottschalk-Gleser content analysis scales: anxiety, hostility and social alienation - personal disorganization. Berkeley: University of California Press; 1969.
Schoenleber M, Roche MJ, Wetzel E, Pincus AL, Roberts BW. Development of a brief version of the pathological narcissism inventory. Psychol Assess. 2015;27(4):1520–6. https://doi.org/10.1037/pas0000158.
Gift T, Cole R, Wynne L. An interpersonal measure of hostility based on speech context. In: Gottschalk LA, Lolas F, Viney LL, editors. Content analysis of verbal behavior. Berlin: Springer-Verlag; 1986. p. 87–93.
Smith JA, Flowers P, Larkin M. Interpretive phenomenological analysis: theory, method and research. London: SAGE Publications Ltd; 2009.
Braun V, Clarke V, Hayfield N, Terry G. Thematic Analysis. Handbook of Research Methods in Health Social Sciences; 2019. p. 843–60.
Hayes N. Theory-led thematic analysis: social identification in small companies. In: Hayes N, editor. Doing qualitative analysis in psychology. Hove: Psychology Press; 1997.
Ng FYY, Townsend ML, Miller CE, Jewell M, Grenyer BFS. The lived experience of recovery in borderline personality disorder: a qualitative study. Borderline Personal Disord Emot Dysregul. 2019;6:10. https://doi.org/10.1186/s40479-019-0107-2.
White Y, Grenyer BFS. The biopsychosocial impact of end-stage renal disease: the experience of dialysis patients and their partners. J Adv Nurs. 1999;30(6):1312–20. https://doi.org/10.1046/j.1365-2648.1999.01236.x.
Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med. 2005;37(5):360–3.
Jackson K, Bazeley P. Qualitative analysis with Nvivo. 3rd ed. London: SAGE Publications Limited; 2019.
Rokach L, Maimon O. Clustering methods. Data mining and knowledge discovery handbook. Boston: Springer; 2005. p. 321–52.
Pincus AL. The pathological narcissism inventory. In: Ogrodniczuk JS, editor. Understanding and Treating Pathological Narcissism: American Psychological Association; 2013. p. 93–110.
Hendin HM, Cheek JM. Assessing hypersensitive narcissism: a reexamination of Murray's Narcism scale. J Res Pers. 1997;31(4):588–99. https://doi.org/10.1006/jrpe.1997.2204.
Glover N, Miller JD, Lynam DR, Crego C, Widiger TA. The five-factor narcissism inventory: a five-factor measure of narcissistic personality traits. J Pers Assess. 2012;94(5):500–12. https://doi.org/10.1080/00223891.2012.670680.
Wright AGC, Stepp SD, Scott LN, Hallquist MN, Beeney JE, Lazarus SA, et al. The effect of pathological narcissism on interpersonal and affective processes in social interactions. J Abnorm Psychol. 2017;126(7):898–910. https://doi.org/10.1037/abn0000286.
Miller JD, Lynam DR, Vize C, Crowe M, Sleep C, Maples-Keller JL, et al. Vulnerable narcissism is (mostly) a disorder of neuroticism. J Pers. 2018;86(2):186–99. https://doi.org/10.1111/jopy.12303.
Russ E, Shedler J, Bradley R, Westen D. Refining the Construct of Narcissistic Personality Disorder: Diagnostic Criteria and Subtypes. Am J Psychiatry. 2008;165(11):1473–81.
Morf CC, Torchetti L, Schurch E. Narcissism from the perspective of the dynamic self-regulatory processing model. In: Campbell K, Miller JD, editors. The Handbook of Narcissism and Narcissistic Personality Disorder: Theoretical Approachers, Empirical Findings, and Treatments. Hoboken: Wiley; 2011. p. 56–70.
Nealis LJ, Sherry SB, Sherry DL, Stewart SH, Macneil MA. Toward a better understanding of narcissistic perfectionism: evidence of factorial validity, incremental validity, and mediating mechanisms. J Res Pers. 2015;57:11–25. https://doi.org/10.1016/j.jrp.2015.02.006.
Ronningstam E. Narcissistic personality disorder: a current review. Curr Psychiatry Rep. 2010;12(1):68–75. https://doi.org/10.1007/s11920-009-0084-z.
OF K. The almost untreatable narcissistic patient. J Am Psychoanal Assoc. 2007;55(2):503–39. https://doi.org/10.1177/00030651070550020701.
Lenzenweger MF, Clarkin JF, Caligor E, Cain NM, OF K. Malignant narcissism in relation to clinical change in borderline personality disorder: an exploratory study. Psychopathology. 2018;51(5):318–25. https://doi.org/10.1159/000492228.
Joiner TE Jr, Petty S, Perez M, Sachs-Ericsson N, Rudd MD. Depressive symptoms induce paranoid symptoms in narcissistic personalities (but not narcissistic symptoms in paranoid personalities). Psychiatry Res. 2008;159(1–2):237–44. https://doi.org/10.1016/j.psychres.2007.05.009.
McWilliams N, Grenyer BFS, Shedler J. Personality in PDM-2: controversial issues. Psychoanal Psychol. 2018;35(3):299–305. https://doi.org/10.1037/pap0000198.
Grenyer BFS. Revising the diagnosis of personality disorder: can it be single, clinical and factorial? Aust N Z J Psychiatry. 2017;52(2):202–3. https://doi.org/10.1177/0004867417741984.
World Health Organization. International statistical classification of diseases and related health problems. 11th ed; 2018.
Stinson FS, Dawson DA, Goldstien RB, Chou SP, Huang B, Smith SM, et al. Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Narcissistic Personality Disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2008;69(7):1033–45.
Keene AC, Epps J. Childhood physical abuse and aggression: shame and narcissistic vulnerability. Child Abuse Negl. 2016;51:276–83. https://doi.org/10.1016/j.chiabu.2015.09.012.
van Schie CC, Jarman HL, Huxley E, Grenyer BFS. Narcissistic traits in young people: understanding the role of parenting and maltreatment. Borderline Personal Disord Emot Dysregul. 2020;7(1). doi: https://doi.org/10.1186/s40479-020-00125-7.
Simon RI. Distinguishing trauma-associated narcissistic symptoms from posttraumatic stress disorder: a diagnostic challenge. Harvard Rev Psychiatry. 2002;10(1):28–36. https://doi.org/10.1080/10673220216206.
Kohut H. Thoughts on Narcissism and Narcissistic Rage. Psychoanalytic Study of the Child. 1972;27(1):360–400.
Kohut H. Forms and transformations of narcissism. J Am Psychoanal Assoc. 1966;14(2):243–72. https://doi.org/10.1177/000306516601400201.
Huxley E, Bizumic B. Parental invalidation and the development of narcissism. J Psychology. 2017;151(2):130–47. https://doi.org/10.1080/00223980.2016.1248807.
Sandage SJ, Moe SP. Narcissism and Spirituality. In: Campbell K, Miller JD, editors. The Handbook of Narcissism and Narcissistic Personality Disorder: Theoretical Approachers, Empirical Findings, and Treatments. Hoboken: Wiley; 2011. p. 410–21.
Welwood J. Toward a psychology of awakening: Buddhism, psychotherapy, and the path of personal and spiritual transformation. Boston: Shambhala Publications, Inc.; 2000.
Levy KN, Ellison WD, Reynoso JS. A Historical Review of Narcissism and Narcissistic Personality. In: Campbell WK, Miller JD, editors. The Handbook of Narcissism and Narcissistic Personality Disorder: Theoretical Approaches, Empirical Findings, and Treatments. Hoboken: Wiley; 2011. p. 3–13.
Levy KN, Meehan KB, Cain NM, Ellison WD. Narcissism in the DSM. In: Ogrodniczuk JS, editor. Understanding and Treating Pathological Narcissism: American Psychological Association; 2013. p. 45–62.
Hersh RG, McCommon B, Golkin EG. Sharing a diagnosis of narcissistic personality: a challenging decision with associated risks and benefits. Curr Behav Neurosci Rep. 2019;6(4):133–40. https://doi.org/10.1007/s40473-019-00193-2.
OF K, Yeomans FE. Borderline personality disorder, bipolar disorder, depression, attention deficit/hyperactivity disorder, and narcissistic personality disorder: practical differential diagnosis. Bull Menn Clin. 2013;77(1):1–22. https://doi.org/10.1521/bumc.2013.77.1.1.
Clarkin JF, Yeomans FE, OF K. Psychotherapy for borderline personality: focusing on object relations. Washington: American Psychiatric Publishing; 2006.
Ronningstam E, Weinberg I. Narcissistic personality disorder: progress in recognition and treatment. Focus. 2013;11(2):167–77. https://doi.org/10.1176/appi.focus.11.2.167.
Tanzilli A, Muzi L, Ronningstam E, Lingiardi V. Countertransference when working with narcissistic personality disorder: an empirical investigation. Psychotherapy. 2017;54(2):184–94. https://doi.org/10.1037/pst0000111.
Penney E, McGill B, Witham C. Therapist Stigma towards Narcissistic Personality Disorder: Lessons Learnt from Borderline Personality Disorder. Aust Clin Psychol. 2017;3(1):63–7.
Miller JD, Lynam DR, Hyatt CS, Campbell KW. Controversies in narcissism. Annu Rev Clin Psychol. 2017;13:291–315. https://doi.org/10.1146/annurev-clinpsy-032816-045244.