Transform Your Relationship with a Narcissist

Stop Narcissists from messing up your life

This is a comprehensive guide that contains every information you need to deal with narcissistic personality. The program offers valuable intuition into how this condition is formed, the effects they have on developmental experiences, and how this personality affects the brain and eventually the information that can help you deal with narcissists. This program is wished-for for people that are fed up with the frustrations of dealing with narcissists. If you are fed up and don't want to put up with them or give up on them, then this program is perfectly for you. This program is not all about solving problems. It helps people who are fed up with frustrations of dealing with Narcissists giving them a better method of solving all the problems from home. You don't have to put up with their frustrations or even give up because there's a reliable solution. The main program is available in downloadable PDF formats. This means you can download the program from wherever you are without any issues. Continue reading...

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Recognizing Areas of Narcissistic Vulnerability

In the following cases, the patients are helped to identify areas of narcissistic vulnerability and to understand the context in which such sensitivity or expectation of rejection may have developed. Common sources of such vulnerability include reactions to traumatic early separations, perceived rejection by a parent, a sense of helplessness and damage related to an early illness, and feelings of rejection because of difference. Certain reactive fantasies that connect to these areas of vulnerability are also examined briefly.

Table 195 Characteristics of Narcissistic Personality Disorder

Typical Thoughts or Beliefs Associated with the Narcissistic Personality self-enhancement component of narcissism. People who are in a relationship with a narcissist often complain that narcissists are self-centered, emotionally cold, and unwilling to reciprocate in the normal give-and-take of a relationship. A final social di ficulty that creates problems for narcissists is the ease wit which they become envious of others. When hearing of the success or accomplishment of acquaintances, narcissists may disparage that achievement. They may feel that they deserve the success more than the persons who worked to attain it. Narcissists may disdain others' accomplishments, particularly in public. A veneer of snobbery may hide strong feelings of envy and rage over the successes of others. Table 19.5 lists the main characteristics of the narcissistic personality disorder , along with examples of some typical beliefs and thoughts persons with this disorder might have. Narcissists sometimes...

Emphasis on Self and the Notion of Narcissism

Powerful than others, more independent, or more liked by others. This style of inflate self-admiration and constant attempts to draw attention to the self and to keep others focused on oneself is called narcissism. Sometimes narcissism is carried to extremes and becomes narcissistic personality disorder (see Chapter 19). However , narcissistic tendencies can be found in normal range levels, characterized as an extreme self-focus, a sense of being special, feelings of entitlement (that one deserves admiration and attention without earning it), and a constant search for others who will serve as one's private fan club. There is a paradox, however , commonly called the narcissistic paradox although a narcissist appears high in self-esteem, he or she actually has doubts about his or her worth as a person. Although the narcissist appears confident and sure o him- or herself, the person needs constant praise, reassurance, and attention from others. Although the narcissist appears to have a...

Addressing Narcissistic Vulnerability

Narcissistic vulnerability is the tendency to react to slights and disappointments with a significant loss of self-esteem (Kohut 1966 Rothstein 1984 Spezzano 1993). As noted in Chapter 1 ( Introduction ), narcissistic vulnerability has been viewed by generations of analysts as central to the development of depression. Because of its crucial role, it is important to help the patient become aware of this vulnerability and to collaboratively explore its dynamics. Narcissistic vulnerability is thought to arise in early experiences of helplessness, loss, or rejection. The sadness connected to these experiences is interpreted by children as a sign of personal damage or weakness, of being inadequate or unloved. They may even interpret their sadness somat-ically, as something physically wrong in the body, with the development of unconscious fantasies concerning bodily damage. If children envy others' strengths in contrast to the damage they imagine because of the sad and vulnerable feeling...

Addressing Angry Reactions to Narcissistic Injury

Typically, patients respond to narcissistic injury with angry reactions and fantasies (Jacobson 1971 Rado 1928 Stone 1986). They tend to have difficulty tolerating these aggressive feelings and may deny them. In attempting to approach the reactive anger, it is essential that the therapist take a nonjudgmental stance, as patients are often critical of these feelings and expect a negative reaction from others.

Closer Look Narcissism and Social Interaction

Narcissism is a personality dimension that involves, at the upper end, high levels of self-absorption and conceited-ness, placing one's own wants and needs above those of others, displaying unusual grandiosity, showing a profound sense of entitlement, and lacking empathy for other people's feelings, needs, and desires (see Chapters 10 and 14 Raskin & Terry, 1988). Those high on narcissism tend to be exhibitionistic (e.g., flaunting money to impress others), grandiose (e.g., talking about how great they are), self-centered (e.g., taking the best piece of food for themselves), and interpersonally exploitative (e.g., using others for selfish ends) (Buss & Chiodo, 1991). Recently, personality psychologists have documented the impact of narcissism on social interaction, providing a fascinating illustration of the influence of personality on social selection, evocation, and manipulation. In terms of selection, narcissists tend to choose people who admire them, who will reflect the...

Psychiatric Perspective

In many ways, codependence is the mirror image of a chemical dependent's self-centeredness and grandiosity. Another term for such self-centered-ness is narcissism. Codependence is the complement of narcissism, just as a glove complements the hand it is shaped to fit. In healthy families, children remain comfortable with the competing, normal childhood needs to be unconditionally loved and validated as worthwhile (i.e., to be the center) and the opposite need to be completely dependent upon all powerful and good parents (i.e., to have others be the center). When parents are unable to tolerate not being the center of relationships, even with their children (which often happens with a chemically dependent parent), children often renounce their own need to be focused on. They become the opposite of narcissistic they become codependent.

Description Of The Group And Client Popula Tion

This kind of intervention is effective with both time-limited and ongoing process groups. The group leader pay attention to the phenomenon of counterresistance in all types of group psychotherapy. Nevertheless, in groups with regressed, aggressive, narcissistic, borderline patients, as well as patients with serious problems relating to others, then one should be doubly attentive. Greater difficulties can surface and one's careful interventions require more skill on the part of the therapist.

Objectives of the Middle Phase of Treatment

By the time the middle phase is nearing an end, the extensive work with the patient's dynamics, described in more detail in the following chapters, results in a sense of comfort between patient and therapist that much has been understood about that patient's particular vulnerability to depressive affects. A reduction in the patient's sense of inadequacy or narcissistic vulnerability is noted, as is a reduction in reactive anger, in guilty self-recriminations, and in shameful self-appraisals. A diminished need to idealize others in order to feel better or to denigrate the self and others is also seen. This has been accomplished through dedicated work on the depressive dynamics as they occur in multiple settings, including in the transference.

Envy or blame of others increasing feelings of being bad unlovable

Narcissistic vulnerability. In this chapter, we illustrate how to explore and identify areas of narcissistic vulnerability common for depressed patients and offer case examples showing how to link these to earlier life experiences. Then we discuss how to work with these realizations in treatment by 1) exploring the negative fantasies patients hold about themselves as a result of these areas of vulnerability, 2) connecting these fantasies to patients' sensitivity to rejection and disappointment to help them recognize their often distorted perceptions about others' response or about their own value, and 3) examining defensive responses to the vulnerabilities in patients' characteristic behavior that actually perpetuate their frustration and disappointment in relationships.

Treatment For Abusers

Men were referred by themselves or the courts, but neither source of referral nor amount of criminal activity had an effect on outcome. Alcohol problems persisted in 32 percent of the men who completed this program successfully, but 56 percent of recidivists had persistent alcohol problems. Recidivists also had higher levels of drug abuse and less empathy as measured on standardized scales. Recidivists also were found to be significantly more narcissistic (self-centered) and gregarious. These findings suggest that alcohol and drug abuse must be addressed when they occur among perpetrators of domestic violence.

Description Of Interventions

Ada, a member of the training group, was very active since the beginning of the session. She shared a dream she had had the previous night, and continued focusing most of the attention on her unresolved problems with her parents, and cried from time to time. Close to the end of the session, Lily, a quiet client, made a personal remark saying that she (number eight of twelve children) feels sometimes neglected by her parents. Ada rejected abruptly Lily's intention to start a dialogue saying that there is no similarity. Lily, talking to Ada, said that she feels, again, a closed door and arrogance in Ada's attitude. Ada said that she doesn't know what Lily is talking about. At this moment I intervened asking Ada to try to look at Lily as a mirror that reflects what Lily sees. Three women participants continue to reflect to Ada what they see of her selfish and narcissistic attitude. Ada was astonished and remained silent until the end of the session.

Identifying Specific Angry Fantasies

As noted in the opening of this chapter, the anger of depressed patients is typically a response to their feelings of narcissistic injury. These angry reactions can include bitterness about feeling unloved, vengeful feelings toward parents or siblings who were abusive, jealousy of those who are better off, and envying others their success, happier families, better health, better looks, or confidence.

Identifying Guilty Reactions to Anger

Guilt stimulated by aggressive reactions to narcissistic injury is discussed at greater length in Chapter 8 ( The Severe Superego and Guilt ). Here, case examples are offered that illustrate the value of identifying patients' angry reactions that stimulate guilt. Helping patients to acknowledge the difference between aggressive thoughts and fantasies and actual aggressive actions is of great importance here, in that the guilt associated with such thoughts is often as intense for depressed patients as if they had actually committed the imagined actions.

The Last American Diet

Looking back through the last three hundred pages, I feel the truth behind Orwell's words. Indeed my own motives in writing this book were far from wholly public-spirited. Besides the usual assortment of desires that plague the narcissistic tribe of writers to be the center of attention, to be admired for one's cleverness, to make money without having to get out of one's chair I was also driven by something else.

What are the symptomsdiagnostic criteria of borderline personality disorder

How is narcissistic personality disorder described What are the symptoms diagnostic criteria of narcissistic personality disorder What other psychiatric conditions are associated with narcissistic personality disorder Narcissistic personality disorder is defined as a grandiose sense of self-importance along with extreme sensitivity to criticism. These patients have little ability to sympathize with others, and are more concerned about appearance than substance. (Think Bill Murray's character in Groundhog Day.)

The Process of Termination

During the termination phase, the therapeutic work focuses on the patient's feelings of narcissistic injury in relation to fantasies of a continued personal relationship with the therapist, feelings of loss and sadness about the ending of this important relationship, and anger toward the therapist regarding the termination or the limitations of treatment accomplishments. A recrudescence of symptoms is sometimes seen as the patient contends with feelings of loss, rejection, and or anger (Firestein 1978).

The Interventions

When the target of an attack retaliated against the attacker, I turned the attention to the retaliator by asking, If someone had used the words that you used to retaliate, what effect would it have had on you This question must be asked very carefully, because in spite of careful preparation for the meaning of questions, it is easy for the patient to experience the question as reproof thus the patient experiences a narcissistic injury. The patient's established trusting relationship with the therapist and the therapist's tone of voice forestalled that misinterpretation. That allowed the therapist to proceed to What do you think your purpose was and How would the rest of you have experienced that remark This again has completely removed the focus from the new patient.

Managing Impasses and Negative Reactions to Treatment

In addition, a subset of patients experience therapy as an adverse, negative process. Although analysts tend to view therapy as a healing, supportive process, these patients can experience it as hurtful and damaging. In some instances, these patients drop out of treatment and constitute treatment failures. It is therefore important to identify factors that may be disruptive to treatment and lead to a negative therapeutic reaction (Asch 1976 Freud 1923). Patients in whom improvement triggers guilt and guilt-driven disruptions to therapy are discussed in Chapter 9 ( Idealization and Devaluation ). Other factors that can contribute to impasses in treatment include significant impairments in patients' sense of basic trust, severe narcissistic sensitivity, and a history of trauma. In these cases, it is particularly important to find ways of strengthening the therapeutic alliance and affirming treatment goals.

Conclusion And Contraindications

This particular ego strength is the buffer to hearing things about himself or herself that are not flattering at times, are not continuously experienced as a narcissistic injury by the client, but rather as observations that can be of tremendous help, in resolving interpersonal difficulties.

Contraindications

These interventions are contraindicated for highly narcissistic and borderline patients who will not be able to tolerate and metabolize the intense feelings evoked. Also, leaders who have difficulties in addressing money matters freely and containing negative feelings may not be successful in using the fee as a clinical tool.

Idealization And The Family Romance

Consciously, though, idealization has been detached from the parents and transferred either to fantasy figures or people whom the child knows. The fantasies serve to preserve the child's narcissism insofar as he elevates his self-worth by identifying with his grander imaginary parents. And the fantasies hold out the hope of rescue, of better times, against the disappointment of the present.

The Erratic Cluster Ways of Being Unpredictable Violent or Emotional

Persons who are diagnosed with disorders belonging to the erratic group tend to have trouble with emotional control and to have specific di ficulties getting along with oth ers. People with one of these disorders often appear dramatic and emotional and are unpredictable. This group consists of four disorders antisocial, borderline, histrionic, and narcissistic personality disorders.

Dimensional Model of Personality Disorders

Widiger (1997) ar gues that disorders simply are maladaptive variants and combinations of normal-range personality traits. The personality traits most studied as sources of disorders are the five traits of the five-factor model, which we reviewed in Cha ter 3. Costa and Widiger (1994) edited an influential book supporting the idea tha the Big Five traits provide a useful framework for understanding disorders. Widiger (1997) presents data ar guing that, for example, borderline personality disorder is extreme narcissism, and schizoid disorder is extreme introversion accompanied by low neuroticism (emotional stability). Extreme introversion accompanied by extremely high neuroticism, on the other hand, results in avoidant personality disorder . Histrionic disorder is characterized as extreme extraversion. Obsessive-compulsive disorder is a maladaptive form of extreme conscientiousness. Schizotypal personality disorder is a complex combination of introversion, high neuroticism, low...

Psychodynamic Models of Depression

Narcissistic vulnerability need for others to buttress self-esteem caretakers leads to narcissistic vulnerability Unsuccessful efforts to idealize others to compensate for low self-esteem The first psychoanalytic writers to develop the concept that depression originates from narcissistic vulnerability, developmental traumas, and conflicted anger included Abraham (1911, 1924), Freud (1917), and Rado (1928). Abraham (1924) posited that the depressed patient had had a severe injury to an early healthy sense of narcissism (self-esteem) by way of childhood disappointments in love, usually at the hands of the mother. Such an injury could stem, for example, from losing a view of the self as a parent's favorite or from disappointments in gaining an alliance with the mother against the father (or vice versa). Onset of the illness in adulthood is triggered by a new disappointment, unleashing strong hostile feelings toward those individuals, past and present, who have thwarted the patient's...

Contraindica Tions

Based on our observations, the following exclusions are recommended (1) individuals with self-centered and aggressive disorders display strong resistance to group work, especially when assuming auxiliary roles. They tend to lack spontaneity and are rigid in their portrayals of significant others that is, they either insulate or attempt to dominate others in the group (2) it is better to rule out individuals with narcissistic, obsessive compulsive (severe), and antisocial personality disorders since individual therapy is more suitable for them and (3) individuals with Cluster A personality disorders and impulse control disorders, such as intermittent explosive disorders, have difficulty functioning in a group composed of individuals with different diagnoses.

Closer Look The Six Myths of Self Esteem

Myth Six Only low self-esteem people are aggressive. For decades many psychologists thought that low self-esteem was an important factor underlying aggressive behavior. Under their tough exteriors, aggressive people were thought to suffer from insecurities and self-doubt. However, recent research has shown that aggressive persons often have quite favorable views of themselves. In fact, extremely high self-esteem can blend into narcissism, which has been associated with bouts of anger and aggression when the narcissist does not get his or her way. If self-esteem is threatened or disputed by someone or some event, especially among high self-esteem persons, then they may react with hostility or violence. People with a highly inflated view of their own superiority, those with narcissistic tendencies, may be the most prone to violent reactions. After a challenge to self-esteem (e.g., getting beaten at a game), a person might protect their self-concept by directing their anger outward,...

The Severe Superego and Guilt

Along with narcissistic vulnerability and related affects of shame, helplessness, or reactive anger, conscious or unconscious guilt often cripples depressed patients. Some patients reveal deep-seated feelings that they are bad or unworthy and are prone to attacking themselves through self-criticisms or punishments when they sense that they are behaving in an aggressive, competitive, or overly sexual manner. Examples of this are the cases of Ms. G in Chapters 4 ( Getting Started With Psychodynamic Treatment of Depression ) and 6 ( Addressing Narcissistic Vulnerability ), who felt devastatingly guilty about aggressive thoughts concerning her mother and boyfriend, and of Ms. V in Chapter 7 ( Addressing Angry Reactions to Narcissistic Injury ), who worried that she was harsh when expressing vindictive feelings toward her father. superego (Table 8-2). The latter outcome, in turn, allows patients greater opportunity for self-expression and for behaviors that will enhance their self-esteem...

Special Considerations

It is important to note that the scope of DPD can be characterized by several features of other PDs, leading to specific variants. Millon and Davis (2000) propose and differentiate five variants of DPD. Specifically, the five variants are ill-humored depressive, voguish depressive, self-derogating depressive, morbid depressive, and restive depressive. Typically, the ill-humored depressive tends to exhibit negativistic features, whereas the voguish depressive exhibits histrionic and narcissistic features. On the other hand, the self-derogating depressive exhibits dependent features, whereas the morbid depressive exhibits masochistic features. Finally, the restive depressive experiences avoidant features. Millon and Davis's variants of DPD encompass practically all possibilities of features with which patients with PD may present. Categorizing patients specifically helps the therapist to decipher interventions and techniques that best meet their needs.

Core Dynamic Formulation for Depression

Rudden et al. (2003) have attempted to integrate these factors into a core dynamic formulation for depression. In this formulation, narcissistic vulnerability is seen as fundamental to the susceptibility to depression (Figure 2-1). This vulnerability results in sensitivity to disappointment and rejection and thus to easily triggered rage, which leads to feelings of guilt and worthlessness. The self-directed rage compounds the injury to an individual's self-esteem, which then escalates the narcissistic vulnerability, and so on, in a vicious cycle. Defenses, including denial, projection, passive aggression, identification with the aggressor, and reaction formation, are triggered in an attempt to diminish these painful feelings but result in an intensification of depression. Precipitants for depression in this integrative model can include either perceived or actual loss or rejection, the failure to live up to a perfectionistic ego ideal, and superego punishment for sexual and aggressive...

Summary And Evaluation

Another reconstruction of Freud's theory concerns the emphasis on the role of the ego relative to the id. Modern theorists have stressed the psychological importance of ego functions, which include planning, developing strategies for achieving goals, developing a stable identity, and achieving mastery over the environment. This is in stark contrast to Freud' s emphasis on aggressive and sexual id ur ges as the twin engines powering psychic life. We discussed two proponents of ego psychology . The first, Erik Erikson, was well known for his alternative theory of personality develop ment, which differed from Freud' s in several important ways, including an emphasis on social tasks and an extension of development through the entire life span. A second important figure in ego psychology was Karen Horne , who was among the firs psychoanalysts to consider the role of culture and social roles as central features in personality development. Horney also started a feminist reinterpretation of...

Central Dynamics of Depression A Summary

Despite their variations in focus, almost all psychoanalysts describing their patients with depression have emphasized narcissistic vulnerability as triggering susceptibility to this syndrome. The basis of this vulnerability varies, however, from disappointments in early relationships to fragile self-esteem based on factors such as childhood experiences of helplessness or reactive fantasies of disempowerment or castration. A sense of narcissistic injury predisposes patients toward the experience of shame and anger, which may become important aspects or triggers of later depressive episodes. Theorists also focus on conflicted anger as playing a key role in the dynamics of depression, although the origin of the anger and the form it takes may vary. In general the anger is seen as triggered by narcissistic injury, loss, immense frustration, or a sense of helplessness. In many of the models explored earlier in this chapter, aggression triggers conscious or unconscious guilt, which...

Prevalence of Personality Disorders

Figure 19.1 indicates the prevalence rates of the 10 personality disorders. Prevalence is a term that refers to the total number of cases that are present within a given population during a particular period of time. The data in Figure 19.1 are based on summaries of several community samples (Mattia & Zimmerman, 2001) and refer to prevalence rates at the time of sampling, e.g., at any given time, how many people are diagnosable with paranoid personality disorder These results show that obsessive-compulsive personality disorder is the most common, at just over 4 percent prevalence rate. Next most common are the schizotypal, histrionic, and dependent personality disorders, approximately 2 percent prevalence each. The least common is narcissistic personality disorder, affecting only 0.2 percent of the population. However , these diagnoses were all based on interviews, and it may be that narcissists are least likely to admit to the more disordered features of their condition. In fact,...

Exploring the Link Between Competitiveness and Aggression

Because depressed patients have a history of intensified aggression connected to their early narcissistic injuries, they often become sensitized to any aggressive impulses and work hard to inhibit them. Many depressed patients specifically link competitive wishes with their preexisting aggressive fantasies. Therefore, competitive feelings are prone to cause the same kind of guilt and self-recriminations as angry feelings and fantasies. Further, competitive fantasies are often linked with wishes for damage to and destruction of a rival. For depressed patients, such fantasies are particularly compelling, in that they may play a part in internal efforts to obtain more love and attention as a way of healing narcissistic wounds.

Development of a Psychodynamic Model of Depression

Psychoanalysts have developed successive, overlapping models to explain the etiology and persistence of depressive syndromes. These models have considered the individual's biological and temperamental vulnerabilities, the quality of the person's earliest attachment relationships, and significant childhood experiences that may have been accompanied by frustration, shame, loss, helplessness, loneliness, or guilt. The impact of such experiences and feelings during formative developmental stages on individuals' perceptions of themselves and others is seen as creating dynamic susceptibilities to a range of depressive syndromes later in life, including narcissistic vulnerability, conflicted anger, excessively high expectations of self and others, and maladaptive defense mechanisms.

Conclusion On Group Therapy

Individual experiential psychotherapy must be handled and utilized cautiously. The clients must be high functioning, have good ego strengths, and willing to receive feedback from the other members. It is important to be careful about who is chosen as a member. Certainly anyone with borderline personality features or disorders, antisocial or narcissistic personality disorders would not be a candidate. Severely depressed clients with poor ego boundaries, active substance users or anyone with marginal intellectual functioning would not be appropriate. In addition, no one should be forced to participate if they are not willing to do so. However, when choosing members for this type of group experience, that is already a consideration.

Comorbid Conditions

As applied to CT for depression with comorbid conditions, the cognitive content specificity hypothesis predicts that in some situations, a patient presenting with depression and a comorbid condition would have dysfunctional cognitions associated with not only depression but also the content of each of the comorbid conditions. Thus, it would be expected that the cognitive content of a person with comorbid depression and anxiety would include both loss and threat, whereas that of a person with depression and a narcissistic personality disorder would include both loss and views of self as inferior and others as superior, hurtful, and demeaning. The implication of this model is that in such situations, CT with a patient with comorbid conditions may require more targeting of additional beliefs than would be the case for someone with pure depression.

Case Example

The therapist's interpreting her patient's sense of fear and helplessness in these interactions first, before pointing out the reactive aggression in her dealings with others, helped Ms. N to feel understood and much less on the defensive. It also served to avoid an early enactment of the transference and countertransference feelings (Gabbard 1995). The therapist might have unthinkingly accepted the role of the judging, punishing parent by focusing on her patient's aggression in her dealings with others, without fully appreciating and interpreting the exquisite narcissistic vulnerability that was at its source. Ms. N would have only experienced such one-sided interpretations as another beating, in which she was victimized and misunderstood yet again by an authority figure who did not fully realize how helpless and rejected she felt. This confirmation of her worst fears would have only served to escalate the patient's depression, rather than to help her more fully understand what was...

Case Example 6

In summary, identifying the genetic origins of the sense of vulnerability, recognizing the fantasies that connect to it, and identifying the reactive envy or blame to which this gives rise is an important task of the beginning and middle phases of the treatment. Helping patients to recognize distortions in perception that stem from narcissistic vulnerability, both in their life and in the transference relationship, and to also recognize counterproductive behaviors and defense related to it, are essential components of any psychodynamic treatment of depression.

Comorbidity

In a group of 34 adolescents hospitalized for mania, West et al 60 found that 86 met criteria for an additional psychiatric disorder. The most common comorbidity was attention deficit hyperactivity disorder (ADHD) (69 ), followed by substance use disorders (39 ), anxiety disorders (31 ), Tourette's syndrome (8 ), and bulimia nervosa (3 ). Focusing on personality disorders, Kutcher et al. 61 determined that among 20 euthymic adolescents with BD, 35 met DSM-III-R criteria for a personality disorder. Borderline and narcissistic personality disorders accounted for the majority of the diagnosis, each being present in 15 of the adolescents. There is limited available data on the presence and significance of other comorbid diagnoses in youth with BD. Various reports have identified elevated rates of pervasive developmental delay 62 and Tourette's syndrome 63 in bipolar youth. Replication is required to validate the findings of these preliminary studies. The following sections will focus on...

Denial

Denial is a core defense mechanism of depressed patients, employed particularly as a means of avoiding hostile and destructive feelings or fantasies. This mechanism is used primarily to keep the experience of anger from consciousness. Patients may also attempt to deny feelings of low self-esteem or narcissistic vulnerability, however, even as they appear to

Books And Articles

Recommendations on the Technique of Psycho-Analysis III). Vol. 12 157-73. (1914.) On Narcissism An Introduction. Vol. 14 67-102. (1920.) Beyond the Pleasure Principle. Vol. 18 1-64. (1921.) Group Psychology and the Analysis of the Ego. Vol. 18 65-143. (1926.) Inhibitions, Symptoms, and Anxiety. Vol. 20 75-175. (1927.) The Future of an Illusion. Vol. 21 3-56. (1940 1938 .) An Outline of Psycho-Analysis. Vol. 23 139-207. Frisch, Max. Montauk. Paperback ed. Translated by Geoffrey Skelton. New York

Amy Pershing

In the therapy office, BED patients often present with exceptional affective attunement to other . Where some eating disorders can be more clinically narcissistic in presentation, patients with BED are often caretakers , the child whose role was often that of oldest , regardless of birth order. These children can sometimes be described as 15 going on 40 . They are typically exceptionally responsible adults, rarely asking for needs to be met in interpersonal relationships, and have a great deal of difficulty either knowing or tolerating their own internal needful child part. They also often present as profoundly somatically

Cluster B

Narcissistic PD Patients diagnosed with narcissistic PD (NPD) typically are resistant to therapeutic interventions because of the characteristics and traits associated with their PD (Beck et al., 2003 Millon & Davis, 2000). They often end up in power struggles with the therapist to prove that they are indeed special. Their pattern is, however, more a low-grade depression, or a series of

Chapter Eleven

The boy's original narcissistic wound is aggravated in adolescence by the hypersexuality of the adolescent male, whose female counterpart is generally not tormented by a comparable hormonal surge. The typical male adolescent experience is one of perpetual sexual arousal without an adequate outlet. This recapitulates the intensely

Case Example 1E

T's case followed the core dynamic of depression in which narcissistic injuries experienced in childhood led to anger and vengeful fantasies of retaliating against loved ones to get what he needed. He felt guilty about these fantasies, further lowering his self-esteem, and feared punishment via castration or some other retaliation. Understanding these dynamics helped to reduce his guilt and allow for a more assertive stance at work and home that also relieved his feelings of inadequacy.

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