The interrupted career group: a preliminary report.

This paper reports on the Interrupted Career Group, a therapy group for individuals whose professional and personal lives have drastically changed due to psychiatric illness and whose attempts to resume a career or other meaningful activities have been unsuccessful. Thirty-two persons with interrupted careers were asked to specify and pursue a vocational, educational, or volunteer track that integrated previous skills and activities with their present life situation and psychiatric limitations. They were also encouraged to discuss feelings of envy, shame, inferiority, rage, and humiliation associated with their interruption or activated in their new pursuits. Twenty-two of the participants effected change by utilizing the group to discuss feelings and efforts connected to resuming an integrated track. Such changes were seen equally in vocational/educational/volunteer activities and emotional functioning, or more in emotional functioning than in vocational/educational/volunteer activities. Ten participants did not show change; they were too psychiatrically disabled, lacked adequate motivation, or were unable to process affects related to actual pursuit of changes and integration. An interactive group process focusing on feelings of shame, envy, rage, inferiority, and humiliation related to experiences of an interrupted career can contribute to improved emotional and vocational functioning.

Differentiating narcissistic and antisocial personality disorders.

The conceptual, clinical, and empirical overlap between the constructs of narcissistic personality disorder (NPD) and antisocial personality disorder (ASPD) is reviewed and their descriptive discriminability is investigated. Twenty-four patients with NPD and 16 patients with ASPD were compared on 33 characteristics for pathological narcissism assessed with the semistructured Diagnostic Interview for Narcissism. The results confirm a sufficiently broad array of similarities that the question of whether these categories should be kept separate (as they are in DSM-IV) is underscored. The results also indicate important areas of difference. The NPD sample was best discriminated from the ASPD sample by their grandiosity, that is, the tendency to exaggerate their talents, and to regard themselves as more unique and superior.

Pathological narcissism and sudden suicide-related collapse.

Psychiatric inpatient admission of three nondepressed young men who escaped deadly self-injury provided an opportunity to study their character organization. Defects in affect-regulatory functions and evidences of pathological narcissism were identified and explored. Each patient had a specific suicide-risk consultation and a psychotherapy evaluation. Each denied intent to kill himself, and none acknowledged experience of depression or the wish to die. Each also denied his suicidal behavior involved significant risks, and each discounted the importance of obvious, identifiable stressors as triggers for it. The interrelation between pathological narcissism and this particular suicidal behavior is discussed. These observations can assist in the assessment of suicide risk in nondepressed patients.

Brief communication: pathological narcissism in bipolar disorder patients.

The occurrence of pathological narcissism in bipolar patients, and the diagnostic relation between narcissistic personality disorder (NPD) and bipolar disorder (BD), were investigated. The Diagnostic Interview for Narcissism (DIN) was administered to bipolar patients when manic and when euthymic. The scores were compared to those of an NPD sample and a control group of general psychiatric patients. Euthymic bipolars do not exhibit a higher level of pathological narcissism or a higher prevalence of NPD than psychiatric patients in general. However, when manic, bipolar patients do appear similar to the narcissistic group, sharing 12 out of 14 of the identifying criteria for NPD. The results support the inclusion of mania in the differential diagnosis of NPD.

Pathological narcissism and narcissistic personality disorder in Axis I disorders.

This paper presents available information on the comorbidity of narcissistic personality disorder (NPD) and pathological narcissism with major mental illness. A review of empirical studies reporting on the prevalence of NPD in Axis I disorders, and of theoretical and clinical literature on narcissistic pathology in major mental illness, forms the basis for an analysis of this interface. The results show that prevalence rates of NPD in Axis I disorders rarely exceed those found in the general psychiatric or personality disorder populations (i.e., less than 22%). NPD was found at high rates in individuals with a substance use disorder (12-38%) or bipolar disorder (4-47%); it was present at very low rates or absent in persons with obsessive-compulsive disorder. Higher prevalence rates were reported in the studies that used the Millon Clinical Multiaxial Inventory I or II than in those that employed the Structured interview for DSM-III Personality Disorders or the Structured Interview for DSM-III-R Personality Disorders--Revised. There is no evidence implicating a significant relationship between NPD and any specific Axis I disorder. A comparison of theoretical and clinical studies with empirical ones reveals major differences in the views regarding the presence and significance of NPD in Axis I disorders. However, the results highlight trends of interacting comorbidity between NPD and substance use disorders, bipolar disorder, depression, and anorexia nervosa.

Changes in pathological narcissism.

OBJECTIVE: This study investigated types of change that occur over time in the psychopathology of narcissistic patients. METHOD: Baseline scores on the Diagnostic Interview for Narcissism of 20 patients, clinically diagnosed as having narcissistic personality disorder, were contrasted with their scores 3 years later by means of t tests and chi-square statistics. The authors then compared these changes in narcissism with the patients' accounts of their life events during the interval between the two assessments. RESULTS: A significant decrease in the overall level of pathological narcissism was found, particularly in the areas of interpersonal relations and reactiveness. At follow-up, 60% of the subjects had reached the cutoff score on the diagnostic interview that indicated significant improvement, and 40% remained unchanged, with a high level of pathological narcissism. A high baseline level of narcissism in interpersonal relations was associated with absence of change at follow-up. Examination of life events in the interval between assessments suggests that changes in pathological narcissism are related to three kinds of experiences: achievements, new durable relationships, and disillusionments. CONCLUSIONS: The instability of narcissistic psychopathology found in this study raises questions about the construct validity of narcissistic personality disorder as a diagnostic category and about the core construct of pathological narcissism.

Identifying criteria for narcissistic personality disorder.

The authors report an exploratory effort to identify useful criteria for narcissistic personality disorder. They used the semistructured Diagnostic Interview for Narcissism to assess 24 narcissistic patients and 58 others on 33 characteristics imputed to pathological narcissism. The following characteristics were significantly more common among the patients with narcissistic personality disorder: a sense of superiority, a sense of uniqueness, exaggeration of talents, boastful and pretentious behavior, grandiose fantasies, self-centered and self-referential behavior, need for attention and admiration, arrogant and haughty behavior, and high achievement. The results provide an empirical basis for developing an improved set of criteria for narcissistic personality disorder.

The diagnostic interview for narcissistic patients.

This report describes the content and development of a semistructured interview, the Diagnostic Interview for Narcissism. The interview evaluates 33 features of pathological narcissism covering five domains of function: grandiosity, interpersonal relations, reactiveness, affects and moods, and social and moral adaptation. Its utility is established by reliability studies and by developing a scoring system from a sample of 24 prototypic narcissistic patients who were compared with 58 others. Because narcissistic personality disorder is a widely used diagnosis whose inclusion in DSM-III-R was without reference to an empirical base, this instrument offers a method for doing much-needed research.

Descriptive studies on narcissistic personality disorder.

This article describes a series of empirical studies on narcissistic disturbances and the narcissistic personality disorder in psychiatric patients. The work began with a survey of the literature and a comparison of three diagnostic systems for narcissistic personality disorder that helped clarify the degree of concordance among the existing systematic descriptions. This work gave rise to the development of a semistructured interview: the Diagnostic Interview for Narcissism. This tool was then used for investigating the following two main questions about pathologic narcissism: (1) Which characteristics identify and best distinguish patients with pathologic narcissism from psychiatric patients with various other diagnoses? (2) Can the Diagnostic Interview for Narcissism identify and distinguish patients with narcissistic personality disorder from patients with other psychiatric disturbances or related personality disorders?

Early discontinuance of borderline patients from psychotherapy.

Sixty newly hospitalized patients with borderline personality disorder who began psychotherapy were followed for 6 months. Thirty-six discontinued their therapy--most often (N = 26) this was due to covert opposition, familial resistance, or angry dissatisfaction with treatment. The dropouts were healthier on some baseline measures than those who continued in therapy. Clinical implications that may diminish dropouts are discussed.

Narcissistic traits in psychiatric patients.

This paper reports a first step towards identifying the descriptive characteristics of what is called pathological narcissism by clinicians. Twenty-three patients with various forms of narcissistic disturbances were evaluated with a semistructured interview for the presence of 27 putative signs of pathological narcissism. They were compared with patients with other psychiatric disorders (n = 28) to determine what features characterize and discriminate them. Fifteen statements proved to be useful in identifying patients with narcissistic disturbances. An additional two discriminate certain narcissistic patients. Implications for differential diagnosis and future research are noted.

Comparing three systems for diagnosing narcissistic personality disorder.

Narcissistic personality disorder (NPD) has been a widely used diagnostic entity. However, opinions about its descriptive validity differ considerably. Hitherto, three diagnostic systems have been developed, those by DSM-III, Akhtar and Thomson, and Kernberg. This paper compares these three systems with respect to concordance among diagnostic criteria, and conceptual themes around which the criteria cluster. The results indicate low concordance among the specific criteria used in these systems but a consensus about the conceptual themes describing self-experience, interpersonal relations and other aspects of NPD. This suggests that NPD is comprised of some core characteristics. However, a reconceptualization of the understanding of NPD must precede further empirical investigations.