The Impact of Pathological Narcissism on Affect Following Social Rejection.

Previous research has shown that narcissism is associated with interpersonal difficulties and maladaptive affective responses to social rejection. In the current studies, the authors examined two phenotypes of pathological narcissism, narcissistic grandiosity and narcissistic vulnerability, and their impact on individuals' affective responses in two distinctive social rejection paradigms. Participants from Study 1 (N = 239), recruited from a multicultural university and Amazon's Mechanical Turk, completed Cyberball, a computerized social rejection paradigm. Participants from Study 2 (N = 238) were recruited from a multicultural university and participated in an in vivo group rejection paradigm in a laboratory. Results indicated that following the rejection in both studies, narcissistic vulnerability positively predicted explicit negative affect and state anger. In addition, the positive relationship between narcissistic vulnerability and explicit negative affect was moderated by greater implicit negative affect in Study 2. The implications and limitations of these findings are discussed.

Psychological trauma, somatization, dissociation, and psychiatric comorbidities in patients with psychogenic nonepileptic seizures compared with those in patients with intractable partial epilepsy.

OBJECTIVE: The objective of this study was to compare patients with intractable epilepsy with patients with psychogenic nonepileptic seizures (PNES) on the presence of psychological traumas, clinical factors, and psychological measures of somatization and dissociation. BACKGROUND: Several studies have reported a high prevalence of psychological trauma in patients with PNES, while less have examined the prevalence of psychological trauma in patients with epilepsy and compared both groups. Reports have been somewhat divergent with some describing significantly higher prevalence in physical abuse, others, in emotional abuse/neglect, and others, in sexual abuse in patients with PNES compared with those in patients with epilepsy. METHODS: This is a retrospective study of 96 patients (61 women, 35 men) with intractable epilepsy (2009 to 2017) and 161 patients (107 women, 54 men) with PNES (2008 to 2018). Demographic and clinical (psychological trauma, depression, anxiety, seizure frequency, and number of antiepileptic drugs) data were collected. The Trauma Symptom Inventory II and the Minnesota Multiphasic Personality Inventory 2RF were administered. RESULTS: Patients with PNES differed significantly from those with intractable epilepsy on sexual trauma (χ2 (5df, N = 257) =9.787, p < .002) and "other" trauma (χ2 (5df, N = 257) = 17.9076, p < .000). On psychological measures, there was a significant difference on Somatization scores in patients with PNES (M = 59.63, SD = 11.47) and patients with intractable epilepsy (M = 53.98, SD = 11.31); t(173) = 2.8396, p = .0051, but no difference was noted on a measure of Dissociation. Subsequent principal components analysis revealed that the first 3 principal components (sexual, physical, and other trauma) explained 74.19% of the variability, and that one principal component (dissociation, somatization, demoralization) explained 61.57% of the variability. However, after adjusting for the effects of covariates, only the presence of trauma discriminated between epilepsy and PNES. CONCLUSIONS: Patients with PNES diagnoses differed from those with epilepsy on a Somatization scale but not on Dissociation or Intrusive Experiences and exhibited significantly higher rates of sexual and "other" trauma compared with those with intractable epilepsy. However, subsequent analyses revealed that a history of psychological trauma was the only condition found to discriminate between patients with PNES and those with epilepsy. These findings suggest that during initial workup and diagnosis, when patients report a history of psychological trauma (sexual or otherwise) a psychogenic nonepileptic etiology should be strongly considered in the differential diagnosis.

Post-traumatic stress and relationships to coping and alexithymia in patients with psychogenic non-epileptic seizures.

PURPOSE: There is increasing evidence that patients with PNES can form subgroups distinguished by emotion dysregulation and comorbid psychological symptoms. The purpose of this study was to determine if patients with comorbid PTSD differ from other patients with PNES in terms of alexithymia and stress coping strategies. METHODS: 156 adult patients with video-EEG confirmed PNES were assessed with the Trauma Symptom Inventory-2 (TSI-2) and diagnostic clinical interview, Toronto Alexithymia Scale (TAS-20), and the Coping Inventory for Stressful Situations (CISS). There were 3 groups: 48 patients with PTSD, 62 patients who had experienced trauma and did not have PTSD, and 46 patients who denied experiencing trauma. RESULTS: One-way ANCOVA revealed a significant difference between groups on reported levels of alexithymia [F(2, 154) = 18.21, p < .001] and use of emotion-focused coping [F(2, 156) = 11.12, p < .001]. Tukey HSD post-hoc comparisons indicated that the PNES/PTSD group had significantly higher mean alexithymia scores (M = 59.54, SD = 12.89) than both the no trauma (M = 49.51, SD = 14.92) and the trauma with no PTSD groups (M = 49.98, SD = 13.27), which did not differ from each other. The PNES/PTSD group was also significantly more likely (M = 62.44, SD = 11.56) than the no trauma (M = 52.87, SD = 13.57) and the trauma with no PTSD groups (M = 52.06, SD = 12.63) to utilize emotion-focused coping strategies. No significant differences were found between groups on use of task- or avoidance-focused coping. CONCLUSION: The study revealed elevated alexithymia and use of potentially more maladaptive emotion-focused coping strategies among patients with PNES and comorbid PTSD. These findings highlight discrete areas to target in treatment depending on comorbid symptomatology, and suggests that PNES, which is often regarded as a homogeneous entity, appears to encompass distinct subgroups.

Assessing the contribution of borderline personality disorder and features to suicide risk in psychiatric inpatients with bipolar disorder, major depression and schizoaffective disorder.

Suicidal behavior often accompanies both borderline personality disorder (BPD) and severe mood disorders, and comorbidity between the two appears to further increase suicide risk. The current study aims to quantify the risk of suicidality conferred by comorbid BPD diagnosis or features in three affective disorders: major depressive disorder (MDD), bipolar disorder (BP) and schizoaffective disorder. One hundred forty-nine (149) psychiatric inpatients were assessed by SCID I and II, and the Columbia Suicide Severity Rating Scale. Logistic regression analyses investigated the associations between previous suicide attempt and BPD diagnosis or features in patients with MDD, BP, and schizoaffective disorder, as well as a history of manic or major depressive episodes, and psychotic symptoms. Comorbid BPD diagnosis significantly increased suicide risk in the whole sample, and in those with MDD, BP, and history of depressive episode or psychotic symptoms. Each additional borderline feature also increased risk of past suicide attempt in these same groups (excepting BP) and in those with a previous manic episode. Of the BPD criteria, only unstable relationships and impulsivity independently predicted past suicide attempt. Overall, among patients with severe mood disorders, the presence of comorbid BPD features or disorder appears to substantially increase the risk of suicide attempts.

Cognitive differences between patients who have psychogenic nonepileptic seizures (PNESs) and posttraumatic stress disorder (PTSD) and patients who have PNESs without PTSD.

OBJECTIVES: The objective of this study was to examine cognitive and clinical differences among three groups of patients diagnosed with psychogenic nonepileptic seizures (PNESs): those with posttraumatic stress disorder (PTSD), those with a history of trauma but no PTSD, and those without a history of trauma. METHODS: Seventeen patients who were confirmed to have PTSD based on the Trauma Symptom Inventory-2 (TSI-2) and clinical interview were compared with 29 patients without PTSD who had experienced trauma and 17 patients who denied experiencing trauma. We analyzed demographic data, psychiatric information, trauma characteristics, and neuropsychological variables in these groups. RESULTS: Our study revealed that patients with PNESs with comorbid PTSD performed significantly worse on episodic verbal memory (narrative memory); had greater self-reported Total, Verbal, and Visual Memory impairments; and had higher substance abuse history and use of psychopharmacological agents compared with patients without PTSD regardless of a history of trauma. CONCLUSION: The present study showed that patients with PNESs diagnosed with PTSD exhibited memory functions that were significantly different from those in patients with PNESs who do not carry a diagnosis of PTSD (regardless of history of trauma). Furthermore, these specific cognitive findings in narrative memory are consistent with those reported in patients with PTSD alone. The present findings contribute to further identifying discrete intragroup differences within PNESs. Identifying a specific psychopathological subgroup such as PTSD will allow clinicians to accurately select treatment.