How to Make the Narcissist Powerless

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. Read more here...

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Antisocial Impulsive And Borderlinenarcissistic Trends

A grandiose dimension has been added to the private self that curtails social perspective and produces narcissistic individuals who become their own most compelling cause in life. It has been claimed that narcissistic personality disorder (NPD) is the defining characterological disturbance of the contemporary world, and that it is a direct by-product of modernity.45 In support of this claim, there is ample clinical evidence that the diagnosis of pathological narcissism is being made much more frequently than in previous decades. This development has been assisted by media socialization that mesmerizes members with youthful advantage, while also inspiring them to entertain continually any private or dissociated urges that could be satisfied through creative consumption. The end product is that the perpetual adolescent of the modern era has become immune to the regulating influence of maturity, while enjoying permission to act impetuously on even the most covert motivations that might...

Narcissistic Personality Disorder

The family physician's reactions to the narcissistic patient are often difficult to manage. The superior, entitled, self-loving, arrogant attitude of these patients can be intimidating. They may elicit feelings of being devalued and inferior. The physician may have concerns about the patient's anger and criticism. Alternatively, the lack of empathy and interpersonal exploitation of these patients can readily provoke the physician to anger, a wish to retaliate with harsh criticism, or a desire to end the patient-physician relationship. The core fears of narcissistic patients are the result of a fragile self-esteem and their need for constant approval and praise from others. They fear loss of admiration, potency, and power, and fear being exploited when vulnerable. Any perceived insult to their grandiose self (Kernberg, 1984, 1992) makes them feel rejected, deflated, and criticized and frequently results in feelings of rage, shame, or humiliation. The narcissistic patient has generally...

Narcissistic Rage

Kohut introduced the concept of narcissistic rage in 1972 (Kohut 1972). It is interesting to note that two other psychoanalytic writers also distinguished a different variety of aggression at almost precisely the same time. Erich Fromm 19721 wrote of malignant aggression, which he differentiated from what he deemed normal defensive aggression because it was a search for vengeance and is cruel, lustful and insatiable (p. 271). Anthony Storr 19721 also noted that a wish for ven geance and cruelty was associated with the experience ol helplessness against a superior force. Kohut characterized narcissistic rage phenomenologically as the need for revenge, for righting a wrong, for undoing a hurt by whatever means, and a deeply anchored, unrelenting pursuit of all these aims which gives no rest to those who have suffered a narcissistic injury p. 108 . Melville's Captain Ahab is the classic literary example. Kohut anchored this phenomenon firmly in the vicissitudes of the development and...

Narcissistic Traits

The Destructive Narcissistic Pattern. Westport, CT Praeger Publications. Donaldson-Pressman, S., & Pressman, R. (1997). The Narcissistic Family Diagnosis and Treatment. San Francisco Jossey-Bass. Forrest, G. (1995). Alcoholism, Narcissism and Psychopathology. Leonia, NJ Jason Aronson. Golomb, E. (1995). Trapped in the Mirror Adult Children of Narcissists in Their Struggle for Self. New York HarperCollins. Lowen, A. (1997). Narcissism Denial of the True Self. Greenwich, CT Touchstone. Schwartz-Salant, N. (1982). Narcissism and Character Transformation The Psychology of Narcissistic Character Disorders. Toronto, ON Inner City Books. Solomon, M. (1992). Narcissism and Intimacy Love and Marriage in an Age of Confusion. New York W. W. Norton.

The Nature of the Discipline

The most significant North American challenge to the received orthodoxy that emerged in the 1970s came in the work of Heinz Kohut, a close personal friend of both Heinz Hartmann and Anna Freud. Deeply steeped in Freudian metapsychology and its ego-psychological elaboration (and a former president of the American Psychoanalytic Association), Kohut became disenchanted with the theory's clinical efficacy, first writh patients diagnosed writh narcissistic psychopathology and eventually with all analyzable patients (Kohut 1971, 19771. Moving away from his conceptual roots, he taught his students to look for more than just the Freudian constellations i.e., narratives) and to let the patient teach you how to analyze him (A. and P. Ornstein, personal communication, January 2010).

Traditional Connectionist Representations

Distributed representations used by traditional connectionist models are not symbolic in the sense defined previously. That is, they cannot represent relational roles independently of their fillers and simultaneously specify which roles are bound to which fillers (Hummel & Holyoak, 1997,2003 a). Instead, a network's knowledge is represented as simple vectors of activation. Under this approach, relational roles (to the extent that they are represented at all) are either represented on separate units from their potential fillers (e.g., with one set of units for the lover role of the loves relation, another set for the beloved role, a third set for John, a fourth set for Mary, etc.), in which case the bindings of roles to their fillers is left unspecified (i.e., simply activating all four sets of units cannot distinguish John loves Mary from Mary loves John or even from a statement about a narcissistic hermaphrodite) or else units are dedicated to specific role-filler conjunctions (e.g.,...

The Freefloating Individualistic Structure Of Identity

This California self is the ultimate expression of modern individualism in its most inward, narcissistic, self-centered, and self-serving form. To the California self, the primary reason for living is to make the right choices and to consume the right things in order to maximize pleasure and minimize pain and, in general, to get the most from life. Yet this identity structure operates at a distance from the stabilizing effect of the wider community. The California self succumbs easily to states of psychic disruption due to its lack of emotional commitment to the commons and an identity that places inordinate emphasis on personal and product outcomes.

The End of Repression as a Psychological Defense

Dysfunctional entitlement is now regarded as a key explanatory factor in certain types of self-absorption psychopathologies that appear to be on the increase today. This includes consumption disorders, personality disorders of the narcissistic and borderline variety, and a range of interpersonal pathologies that relate to imbalances of personal gain. Even the recent upsurgence of kleptomania in Western culture can be interpreted in relation to short-term gain strategies that are motivated by exorbitant levels of experienced entitlement. The problematic feature of this arrangement is the considerable risk of dejection, self-disappointment, and depression that arises when expectations and entitlements go unrealized, or when dedicated self-servicing does not translate into positive emotional outcomes.

Modernity Consciousness And Emotion

Among the mental health consequences of externalized consciousness are heightened propensities toward narcissism, alienation, intimacy problems, meaning-related disorientations, affective communication impairments, fetishistic attachments to material objects, reality confusion, and self-knowledge gaps. As individuals who have come to relate to emotion and consciousness as exchangeable commodities, moderns have become distanced from the communal operations that historically have immunized members from a range of psychopathologies. The next chapter explores what has happened to some age-old mental health prophylactics as a consequence of the commodification of culture and the launch of consumer consciousness.

Childhood Experiences and the Adult World

Consider the present illness from the vantage point of the entire biographical narrative, with special (but by no means exclusive) emphasis on the first two decades of life. The present is typically understood in the context of the past, whether it be the past of drives, infantile phantasy, mother-infant relationship, family relational patterns, or narcissistic mirroring. icant and how they achieve their effects. Childhood trauma, such as physical or sexual abuse, neglect, or abandonment, is consistently recognized as formative, but the means by which such experiences work their effects is a subject of debate. Analysts informed by different conceptualizations of how the mind develops have different ideas about how the events of childhood shape and distort the adult personality. For example, the psychoanalyst who maintains the overarching importance of the repressed oedipal constellation in adult psychopathology will, at least in part, conceptualize the troubles of a patient...

Prevalence and incidence of secondary organic personality change following TBI

Streeter, van Reekum, Shorr and Bachman (1995) noted that in a comparison of 54 males with borderline personality disorder to 49 psychiatric control patients there was a much higher incidence (42 ) of TBI in the borderline group as compared to the controls (4 ). As the TBI had occurred before the full expression of the personality disorder, the authors felt that the TBI had been a cause rather than a result of the TBI. Hibbard, Bogdany et al. (2000) noted that using the Structured Clinical Interview for the DSM-IV on 100 participants recruited from a larger pool of 438 TBI patients, 24 of the sample could be diagnosed with a personality disorder prior to the TBI, whereas 66 met the diagnostic criteria for at least one personality disorder after the injury. The most common forms of post-TBI personality disorder were borderline (34 ), avoidant (26 ), paranoid (26 ), obsessive-compulsive (27 ), and narcissistic (14 ). Those patients who had had personality disorder before the TBI were...

Developmental Pathology

Pathology of the grandiose self arises from the difficulty of the caretakers to respond to the child's needs for confirmation and pleasure in his or her displays or very existence. Depressed, preoccupied, morally offended, impatient caretakers may cause the child to repress or split off these aspects of the self. Children may also experience ordinary situations of inattention as traumatic lack of responsiveness. The inner experience of unresponsiveness, hence, is an outcome of the matrix of the interaction between the child and the caretaker or the sclf-selfobjcct unit. The result of the trauma to and derailment of the development of the grandiose self is either its repression or disavowal, or often both. When this occurs, the source of one's vitality and the drive to achieve is unavailable to the person. Hence, the symptomatology of the repression of the grandiose self is typical of the narcissistic character disorder and includes hypochondria, sensitivity to slights, and lack of...

Psychodynamic Model of Panic Disorder

Busch et al. (1991) and Shear et al. (1993) developed a psychodynamic formulation for panic disorder based on psychological, clinical, and temperamental observations and studies about panic patients. Beginning with the studies of temperament of Kagan et al. (1990) and Biederman et al. (1990), the authors postulated that panic patients are constitutionally predisposed to fearfulness of unfamiliar situations early in life. This is based in part on Rosenbaum et al.'s (1988) finding that children of patients with panic disorder, who are likely to develop panic, are found to have a high rate of behavioral inhibition. Behaviorally inhibited children manifested long latencies to interact when exposed to novelty, retreated from the unfamiliar, and ceased play and vocalizations while clinging to their mothers (Biederman et al., 1990, p. 21). In addition, children with behavioral inhibition demonstrated higher rates of childhood anxiety disorders (Biederman et al., 1990). Rosenbaum et al....

Discovery and Early Developments

Finally, it seems worth noting that the discovery of transference is a rather astonishing victory over personal narcissism. To come to the conclusion that a person who makes an intense declaration of love to you does not really love you but loves .son eone else in an act of transference takes considerable self-esteem and reflectivity. To the physician it represents an invaluable explanation and a useful warning against any tendency to counter-transference that may be lurking in his or her own mind.

Other Mental Disorders

Possible associations between the norm-breaking behavior of people who could be diagnosed with antisocial personality disorder and creativity have been mentioned above there is conceptual overlap between a norm-breaking lifestyle, genre-busting creativity, unconventional and ground-breaking artistic products. There have also been associations suggested with narcissistic personality disorder, with the argument that to feel one's creative work is valuable and worth showing to the wider world it is necessary to have at least some narcissistic characteristics, such as belief in one's own worth, grandiosity, and

The Sacralization And Ritualization Of Consumption

The state of grace has become one in which the disciple moves up or forward. Salvation and immortality take on earthly meanings in terms of market success and visible signs of wealth. In particular, Christianity has opened itself to capitalistic frameworks that can atone for, and respond to, the rapacious dispositions of the modern consumer. Its traditional teachings have been amended in order to tolerate consumer themes, and to inject materialistic zealousness with an aura of piety.28 Narcissistic cultural themes have clashed seriously with Christian love-of-other dictates, causing revisions wherein essentially self-interested followers can remain holy as long as they do not consciously hurt others in the course of their self-serving pursuits.

Solitude Asociability and Antisociability

Yet some of the people who have contributed most to the enrichment of human experience have contributed little to the welfare of human beings in particular. It can be argued that some of the great thinkers were self-centered, alienated, or 'narcissistic' more preoccupied with what went on in their own minds than with the welfare of other people.

Was Plaths Writing Helpful or Harmful

Person and the audience. (Presumably they mean critically successful, for even poor poetry can serve a useful psychological function for the writer, even if it is merely cathartic.) To be successful, poetry must first achieve a balance between the writer's use of the audience to serve his or her own narcissistic needs (a type of exhibitionism) and the desire to give others a way of structuring the terrors and anxieties that afflict us all. The writer must also achieve a balance between the potentially destructive conscious and unconscious forces motivating the writing and the constructive desires to harness these forces for the purpose of writing creatively. In terms of psychoanalysis, the writer must balance primary and secondary process mechanisms. The writer must also compromise between the fantasy permissible in writing and the acceptance of reality necessary for successful living. When they applied their ideas to Sylvia Plath, Silverman and Will asserted that the successful...

Benefits of Psychoanalysis Compared with Benefits of Medication

A learns that she has not been invited to a party given by a friend and notes a change from a light-hearted mood to a somber one, followed by reflection about the last several interactions with the friend, and how to cope with having been excluded. She thinks over whether to talk to her friend about it, ignore it, or exclude the friend from her own future guest lists, and she eventually regains a neutral mood. Ms. B, an individual with significant narcissistic vulnerability, experiences the same news by becoming overtly depressed and suicidal after ruminating for some time about being unlovable and worthless and engaging in fantasies of revenge. She did not make a connection between the depressive reaction and the experience of rejection. At her next session, Ms. B reports to her psychiatrist feeling more depressed without identifying any precipitant for the worsening the psychiatrist might then assume that the medication is not working, and prescribe another medication...

Theory of Neurotic Conflict

Neurotic conflict occurs when none of the psychic parts is successful at organizing and disciplining the others Republic IV, 444a see also Books VIII, IX . So, for example, the narcissistic component might experience a certain sexual temptation as shameful, but appetitive desire goes for it anyway. The impasse is intrapsychic conflict in which powerful feelings of temptation struggle against feelings of shame, humiliation, and worth-lesssness. Socrates tells the story of Leontius, who, when he was walking back to town, saw some corpses outside the walls of the city

Dynamic Theory of Personality Organization

For instance, we can speak of a narcissistic personality when the narcissistic component of the psyche takes control and imposes some kind of organization over the other parts. In the narcissist, the more appetitive desires for sex are disciplined to an overriding desire for admiration. Now it becomes important to have sexual relations with someone who will contribute to one's glory. And reason is deployed as a primarily cal-culative faculty figuring out which are the next good moves if one is to achieve celebrity. Thus, we have the formation of what Plato calls limocratic man, the lover of honor Republic VIII, 549c-550 cf. IX, 580d-581c).

Family Background and the Early Years

The presence of twin brothers and three sisters gave the young Stieglitz a ready made group. He apparently envied the twinship of his brothers and some biographers think he was always looking for his twin or soul mate. Perhaps, a parallel story line is that he became especially gifted at getting his mother's attention despite the always present competition of bright and clamorous siblings as well as his not-to-be-overlooked dashing father. Hedwig Stieglitz called her son her 'little Hamlet' - sensitive, theatrical, moody, and hard not to notice. He developed a philanthropic narcissism early on, an unusually skillful way of managing both sibling rivalry and oedipal conflicts. One apocryphal tale finds him offering money and sandwiches to an organ-grinder who appeared many times at the family home during dinner. When asked by Hedwig years later, did he remember the indigent organgrinder He replied that of course he did and furthermore, he was not giving to the organ grinder but really...

Prevalence of Specific Dsmiii Dsmiiir or Dsmiv Personality Disorders

Narcissistic PD Narcissistic Personality Disorder. The essential feature of this disorder is a ''pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy'' (APA, 1994). There has not been a great deal of empirical work done on narcissistic personality disorder in general, and very little epidemiological work in particular. Although there is considerable clinical interest in the disorder, it has only recently been included in official nomenclatures. Narcissistic personality disorder became part of the American nomenclature in 1980 with DSM-III and there is no counterpart to it in ICD-10. Gunderson et al. (1991b) reviewed several studies that reported the prevalence of DSM-III-R narcissistic personality disorder in clinical populations (Dahl, 1986 Frances et al., 1984 Skodol, 1989 Zanarini et al., 1987) and reported prevalence rates ranging from 2.0 to 16 . The prevalences in nonclinical samples reported in Table 3 range from 0.0 to 0.4 with a...

Illness as a Grieving Process

Physical illness may involve loss in the following areas independence, sense of control, privacy, body image healthy self, relationships, roles inside and outside the family, self-confidence, self-esteem, productivity, self-fulfillment, future plans, fantasies of immortality, hindered movement, familiar daily routines, uninterrupted sleep, ways of expressing sexuality, and pain-free existence (Lewis 1998). Many of the assumptions of the child's daily life, including the sense of future, can be shattered by the diagnosis of an illness. Youngsters may experience overwhelming threats and fears including threats to narcissistic integrity and self-esteem, regressive fear of strangers on whom the patient must rely, separation anxiety, fears of loss of love and approval, fear of loss of control of bodily functions, and fear of pain and humiliation, as well as guilt and the fear of retaliation reflecting the unconscious belief that illness may be a punishment for past behavior (Lip-sitt 1996...

Reference to Theoretical Models Introduced in Chapter

Worden (2002) listed five factors regarding failure to grieve relational (e.g., ambivalent or narcissistic relationships) circumstantial (e.g., uncertainties regarding death or multiple losses) historical (e.g., past complicated losses such as early loss of parent) personality (e.g., how one copes, or how well one is integrated) and social (e.g., socially unspeakable death or lack of support systems). He further discussed types of complicated grief and showed the relationship of each complication to his 'tasks of grief' work. He suggested that assessment identifies which tasks have not been completed, and that intervention begins at this point of immobility before attempting to continue through the normal tasks of grief counselling. One example would be delayed or inhibited grief, in which the bereaved has not been able to get in touch with or express the emotions involved. Although there may be various reasons for this difficulty, Worden suggests that the counsellor view the client...

Films on Themes Directly Concerning Psychoanalysts

The second category of films popular among psychoanalytic critics includes those many works that deal with themes also familiar to analytic inquiries, thus covering disparate aspects of the human condition crises in subjectivity related to developmental stages or to acute existential and moral dilemmas by such directors, to name just a few from different cinematic traditions, as Ingmar Bergman, Akira Kurosawa, and Krzysztof Kieslowski) loss and mourning conflictual or abusive family constellations (Yasujiro Ozu, Luchino Visconti, and Satyajit Ray), sometimes with an emphasis on incestuous themes different forms of mental pathology, such as depressive and suicidal, neurotic, or narcissistic disturbances (Woody Allen) sexual perversions and gender confusion (Pedro Almodovar) drug addiction and alcoholism dissociative, paranoid, and psychotic states and so on. It must be noted here that unfortunately many movies on psychosis, including some of the best such

What Are Personality Disorders

Detailed descriptions of each of the 10 personality disorder diagnoses can be found in the DSM-IV. However, because we believe that the clearest linkages between personality disorders and physiology may lie at the level of symptoms and their interrelationships rather than at the level of existing diagnoses, we will focus more on the symptoms that comprise the diagnoses rather than on the diagnoses themselves. The 10 personality disorders listed in the DSM-IV can be grouped into 3 clusters on the basis of similar symptoms. Specifically, people diagnosed with a personality disorder in cluster A (paranoid, schizoid, or schizotypal) tend to show odd and eccentric behavior. Interpersonally, they are often reclusive and suspicious. People diagnosed with a personality disorder in cluster B (histrionic, narcissistic, borderline, or antisocial) tend to show dramatic, emotional, and impulsive behavior. People diagnosed with a personality disorder in cluster C (avoidant, dependent, and...

Through Scopes Broad and Narrow

About who can benefit from psychoanalytic therapy. A common criticism of the classical school had been that, in keeping with Freud's early view, the more disturbed patients could not be helped by psychoanalysis. Freud had divided the functional mental disorders into three broad classes the transference neuroses, the narcissistic neuroses, and the aklual neuroses (neurasthenia, anxiety neurosis, and more tentatively, hypochondria). These last, he thought, were not psychogcnically caused but resulted instead from toxic bodily states. He thought they were somatic medical illnesses following the model of thyrotoxicosis. The transference neuroses such as hysteria and obsessional neurosis arose in patients who were capable of forming relationships with other persons and therefore capable of forming psychoanalytic transferences during treatment. Because of this capacity they were in principle capable of being helped by analytic treatment. The narcissistic neuroses were an entirely different...

Psychosomatic aspects of atopic dermatitis

Every illness also signifies a narcissistic insult if self-esteem problems have already existed prior to the illness, then an adaptive reaction to the illness may prove difficult. For example, a 33-year-old neuroder-mitis patient was enraged every morning when looking into the mirror however, at the same time she was also

Depression Cultural Catharsis And Modern Rage

The disappearance of cultural prescriptions for emotional catharsis is exacerbated by a higher degree of negative emotion that somehow must be managed. There is a resultant accumulation of impounded emotion that, if acted upon without cultural direction, can culminate in irrational displays of anger and rage. In this regard, the term raging self is sometimes used to describe the conditions of modernity that culminate in infantile psychic tantrums that emerge when the fueling of grandiosity and narcissism is followed by frustration.10 As a result of frustrated desire and thwarted narcissism, an excess of unresolved emotion may increase the risk of depression. Even if some discharge can be accomplished by way of cathartic consumer strategies, these tend not to be effective enough to fend off eventful depression. Although internalized negative emotion may set some of the groundwork for depression, it is important to consider cultural mediation processes that serve to regulate emotion....

Antisocial Personality Disorder Malingering and Factitious Disorders

Common physician reactions to a patient with antisocial personality disorder are feelings of being used, exploited, or deceived. This can lead to physician anger and wishes to be free of the patient, uncover lies, and punish or imprison the patient. These patients fear that they will become vulnerable, lose respect or admiration from others, and become easy prey to manipulation when they become ill. They expect to be exploited, demeaned, or humiliated. Like the narcissistic patient, they often have low self-esteem, excessive self-love, compensatory feelings of superiority, grandiosity, recklessness, emotional shallowness, and show a lack of concern for others. They often react to medical care with entitled demands for special treatment. When caught in dishonesty, they may angrily attack or devalue the physician. They may resort to other psychopathic manipulations of deception, lying, cheating, or stealing. In fact, their friendly, facile, slick, superficial charm, and intelligent...

Clinical Presentations

Her husband and children and that her narcissistic vulnerability had tragically limited her capacity to realize her considerable potential. She was subject to bouts of gastrointestinal distress and felt miserable much of the time but denied problems with sleep, appetite, or energy level.

Phantasy See Fantasy Phantasy

Pre-oedipal A term describing the psychic organization, including drives, defenses, and self representations and object representations, specific to the phases of development before the oedipus complex. Pre-oedipal organization is associated with more primitive forms of psychopathology, such as narcissistic or borderline personalities, but the persistence of some pre-oedipal features of psychic life is ubiquitous, and these features may become prominent in regressive states even in individuals who arc primarily organized around oedipal conflicts.

Clinical Features

Substantial comorbidity exists between BDD and depression, OCD, social phobia, delusional disorder, anorexia nervosa, gender identity disorder, and narcissistic personality disorder. Kaplan et al. (1994) reported that 20 of patients with BDD have attempted suicide, whereas 22 -29 of patients with a history of child maltreatment have attempted suicide. Didie et al. (2006) found that nearly 79 of 75 subjects with BDD reported a history of childhood maltreatment, such as physical, sexual, and emotional abuse or physical neglect.

The Seductive Patient

One of the most difficult types of patients for the novice to interview and examine is the seductive patient. In many ways, it is more difficult to deal with the seductive patient than with a hostile patient. Many of these patients have one of the personality disorders (e.g., histrionic, narcissistic) and harbor fantasies of developing an intimate relationship with their physician. These patients are often attractive and tend to be flashy in the way they dress, walk, and talk. They commonly offer inappropriate compliments to the interviewer to gain his or her attention. The patients are frequently emotionally labile. Not uncommonly, these patients expose themselves physically early in the interview. The interviewer may elect to cover the patient, but usually this is unsuccessful, as the patient may expose him herself again. It is difficult for the interviewer to cope with his or her own feelings when he or she is attracted to such a patient. The feeling of attraction is a natural one,...

Personality Style vs Personality Disorder

The distinction between personality style and a personality disorder is a matter of degree. Personality styles tend to be relatively stable over a lifetime but can be modified by psychotherapy or needs to adapt to the environment. Personality disorders are also stable, but are more difficult to modify, if at all, and then by long-term or special forms of psychotherapy or by life events. Personality styles that become rigid, extreme, maladaptive, or damaging to self or others, or that lead to social or occupational impairment, are called personality disorders. Although everyone is unique, there seems to be a set of personality styles and disorders that are commonly encountered. Some personality disorders can be recognized in the movies (schizotypal personality disorder, Robert DeNiro in Taxi Driver narcissistic personality disorder, Tom Cruise in Top Gun dependent-borderline personality disorder, Bill Murray in What About Bob ).

Patient Behaviors Adherence and Use of Medical Services

That might improve medical adherence and health outcomes. In general, patients with cluster A personality disorders (paranoid, schizoid, and schizotypal) tend not to adhere to medical recommendations and underuse medical services. They may require outreach to involve them in their own medical care. Cluster B patients (antisocial, histrionic, borderline, narcissistic, and self-defeating) tend to have variable adherence to medical recommendations and may misuse, overuse, or underuse medical care. Cluster C patients (dependent, obsessive-compulsive, avoidant) tend to adhere to medical recommendations because of fear of the consequences of nonadherence. They are ambivalent users of the medical system and tend to use medical services appropriately when others are involved in their care.

Therapeutic Interventions

Verbalize the powerlessness and unmanageability that results from narcissistic traits and addiction. (1) 2. Verbalize an identification of several narcissistic traits and describe how they contribute to addictive behavior. (2, 3) 3. Complete psychological testing or objective questionnaires for assessing narcissistic traits. (4) 1. Using a 12-step recovery program's Step One exercise, help the client to see that narcissistic traits and addictive behavior lead to a state of powerlessness and un-manageability. 2. Assist the client in identifying his her narcissistic traits, and how they can lead to addictive behavior. 3. Help the client to identify times when narcissistic traits and addictive behavior led to negative consequences. 4. Administer to the client psychological instruments designed to objectively assess narcissistic traits (e.g., Millon Clinical Multiaxial Inventory MCMI ) give the client feedback regarding the results of the assessment. 5. Teach the client how a 12-step...

Ethics in Psychoanalysis

Relativism inconsistent with any rational wray of adjudicating among rival moral standards, which apparently vary systematically with the vicissitudes of child development, personality type, and sociocultural context (see Hartmann 1960). The body blow to traditional ethics wrrought by the cumulative effect of these and other psychoanalytic doctrines is seen by contemporary cultural critics as partially responsible for the culture of narcissism and privatism that pervades modern Western societies see Bcllah et al. 1985 Lasch 1979 Rieff 1961, 1968 Wallwork 1991). This is one reason why today many potential patients are so profoundly suspicious of psychoanalysis. One problem with treating therapeutic aims as non-moral health values is that the concept of mental health cannot be separated from moral and ethical considerations. Mental health is neither a statistical norm nor the absence of psychic discomfort. A patient with an average state of depression scarcely represents the...

Later Years

Consideration of these later trends and critiques is complicated by the difficult task of tracing the influences on Freud by his contemporaries and identifying the residues of ideas introduced by earlier dissenters. To this day, there is conflict about the legacy of these dissenters. Some thinkers, especially those who espouse some form of later theory argue that key dissenters introduced vital ideas that Freud did not acknowledge or immediately accept but that later found their way back, their origins unacknowledged, in psychoanalytic theory. For example, it has been argued that the exiled Adler 's influence was felt in Freud's eventual introduction of aggression into his own theoretical framework with the dual instinct theory (Ellenberger 1970 . Cooper believes a similar thing occurred with Rank and Jung. Rank's theory of the birth trauma emphasized issues of loss and merging as the original sources of anxiety Freud .eventually revised his own theory of anxiety to take into account...


This is a pivotal perspective that continues to emerge throughout the entire grief experience. Different aspects of this perspective will demand attention at varying times, often causing the client to feel drained of energy, unable to think or function. It will be important, early in the assessment, to listen for styles and characteristics of personalities and to assess both premorbid and present personalities of the clients. Ask the clients if they view themselves as being a different personality before the loss event. Use questions that encourage responses that provide information about clients in relationships with others and about their own sense of personal self-worth. Listen for responses that might indicate personalities that are dependent, histrionic, narcissistic, compulsive, and the like. A client's personality and how one views himself or herself are an important criterion in resolution of loss and grief.

Depressive Disorders

DSM-IV-TR outlines numerous affective disorders and provides reliable diagnostic criteria. A depressive disorder can be the final common pathway for a variety of insults, including the loss of function following a physical injury, the loss of sleep due to pain, the narcissistic injury of being fired, and the fear following harassment. For some individuals, the resultant symptoms may be consistent with an adjustment reaction with depressive features. For others, the accident or event may result in a major depressive disorder. When confronted with a depressed plaintiff, the psychiatrist should take care to make an accurate diagnosis and pay special attention to causation (see discussion Record reviews revealed that while in college Ms. D took an overdose of pills, resulting in a psychiatric hospitalization. She returned to college 6 months later and completed her studies cum laude. She married at age 26 years and had two children. Her husband committed suicide, and his parents blamed...

Edith Jacobson

Otto Kernberg, in his contribution to psychoanalytic theorizing, began by extending Jacobson's and Mahler 's work toward a blending of the drive model with the relational model. He wras the first American theorist to declare himself a Freudian (retaining the language and thinking of dual instinct theory) while stating explicitly that he drew from the writings of object relations authors (Greenberg and Mitchell 1983). He characterized his work as object relations theory but not in the sense used by Fairbairn. Kernberg employed a more restricted definition of object relations as part of an integrative model that draws on several sources. I lis focus was on the detailed buildup of internal representations of self and object that begin with the infant-mother relationslup and that are colored, critically, by feeling states (derived from the libidinal and aggressive drives . Kernberg's is a structural model of personality development and of psy-chopathology that incorporates many aspects of...

Why revise axis ii

In trying to reduce comorbidity, DSM work groups have been forced to gerrymander diagnostic categories and criteria, sometimes in ways faithful neither to clinical observation nor empirical data. For example, they excluded lack of empathy and grandiosity from the diagnostic criteria for antisocial PD to minimize comorbidity with narcissistic PD, despite evidence that these traits are associated with both disorders (Widiger & Corbitt, 1995). 8. DSM-Axis II fails to consider personality strengths that might rule out personality disorder diagnoses for some patients. For example, differentiating between a patient with narcissistic personality disorder and a much healthier person with prominent narcissistic dynamics may not be a matter of counting symptoms, but rather of noting whether the patient has such positive qualities as the capacity to love and to sustain meaningful relationships characterized by mutual caring.


This also touches on a sense of grandiosity and narcissism that may also be associated with creativity and with depression. (Note that while Aristotle's ideas regarding genius and madness referred to a 'melancholic' temperament, the relationship between this use of'melancholia' and current ones is complex.)

Self Psychology

Sell-psychological perspectives emerged in large part because of a perceived need to provide clinicians with a more phenomenological, experience-near language to describe the development of the self and its disruptions. The work of Heinz Kohut 11971, 1977, 1984 Koliut and Wolf 1978 , in particular, largely based on his experiences treating narcissistic patients, emphasized the importance of the mirroring function of parents in relation to the need forage-appropriate mirroring of feelings of self-worth, ambition, and grandiosity. According to Kohut, in normal development, such mirroring, in combination with age-appropriate frustrations of narcissistic needs, leads to a relatively stable and essentially positive sense of self and realistic ambitions through a process of what he called transmuting internalizations. Hence, beginning with caregivers, others must serve in part a function as self-objects, and phase-appropriate frustration of the child's needs for grandiosity and ambition...


We are now in a position to integrate some of the findings described above. In strictly cognitive terms, it is well known that the right perisylvian convexity is specialized for spatial cognition. In psychoanalytic terms, it appears that damage to this area undermines the patients' ability to represent the relationship between self and objects accurately (a function that is, of course, a form of spatial cognition). This may in turn undermine object relationships in the psychoanalytic sense Object love (based on a realistic conception of the separateness between self and object) collapses, and the patients' object relationships regress to the level of narcissism. This results in narcissistic defenses against object loss, rendering these patients incapable of normal mourning. They deny their loss and all the feelings, including external perceptions associated with it, using a variety of defenses to shore up this denial whenever the intolerable reality threatens to break through.


Of power will accuse the authorities of 'pretence' and 'hypocrisy'. The favoured interpretation, whether on the right or on the left, will accrue to itself an aura of 'objectivity', when that is precisely what the 'as if' maintains.11 It is insidiously easy to move from the faith that we are in perfect agreement, the faith that is necessary to effect the initial act of rough coordination, to the narcissistically consoling view that the other necessarily perceives exactly as we do. But what proves comic or tragic is a subject's endeavour to hold to the self-defeating interpretation in defiance of the clearest clues to a second one.12 Lacan warns against such narcissistic rigidifying of the Symbolic (his term for the order of language that constructs us as speaking subjects and draws us together), calling it a 'formal stagnation'

Carolyn Zerbe Enns

The therapist my client had seen worked from a classical psychoanalytic model that viewed women as passive, narcissistic, and masochistic. This triad of feminine traits had its origins in Sigmund Freud's4 views about the differences between the sexes and was further developed by some of his followers, including women psychoanalysts such as Helene Deutsch.5 With regard to masochism, this approach proposed that women may unconsciously seek out pain and suffering, and may become attuned to these experiences of pain through childbirth and other life experiences. Freud's

Mom Fctish Photos

Pathological grandiose self (Kernberg) The central mental structure in narcissistic personality disorder, which consists of a condensation of elements of the idealized object, the ideal self, and the real self. Though it may desenbe similar phenomena to Kohut'sgrandiose self, it differs in that, according to Kernberg, it is a result of a pathological line of development rather than the persistence of a normal developmental phase.

Karl Abraham

Whereas Freud posited a primary form of narcissism, Klein saw drives as linked to objects from the outset. Klein's is a drive theory and an object relations theory. Object relatedness exists from birth, and the object is, ah initio, integral to all psychological processes. Whereas Freud viewed independent drives as making their aim the search for an object, Klein argued that it was not possible to distinguish drives from relationships.

Jennifer Radden

One last preliminary until rather recent attention by contemporary theorists outside analytic philosophy and psychoanalysis, commentaries on Freud's writing have more often quoted from than thoroughly analysed Mourning and Melancholia. Philosophers have not provided much by way of systematic analysis of this particular text either, in comparison with their close examination of other writing of Freud's, and the philosophical analyses which do exist differ widely in their view, and use, of this work. For those who cast melancholia as a form of neurotic or unresolved grief, and a failure of proper mourning, this is an essay about melancholia understood as a rare, pathological condition (see Mitchell 1974 Cavell 1993). For those who read the introjection, identification and narcissism Freud introduces here as a feature of all mourning, it is an essay about narcissism and (normal) mourning (see Rorty, in this volume). For those directing their attention to the splitting of the ego proposed...

WRD Fairbairn

The principles of infantile innocence and entitlement that anticipated the work of Bowlby on attachment. Fairbairn's conception of endopsychic structure depicted the psyche as a system of egos and internalized objects for which splitting and regression function as defensive operations. Endopsychic structure was, for Fair-bairn, the indicator and subsequent cause of pathology'. Finally, Fairbairn discovered the existentialist domain of Schizoid isolation and withdrawal, which has had important ramifications for the treatment of traumatic, symbiotic, borderline, and narcissistic personality disorders Grotstein and Rinsley 1994),

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