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Disorders of Narcissism

Diagnostic, Clinical, and Empirical Implications

Edited by Elsa Ronningstam, Ph.D.

  • ISBN 978-0-88048-701-6
  • Item #8701

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Within the last few decades, important clinical, theoretical, and empirical findings have stimulated enormous discussion and controversy regarding the nature of pathological narcissism and the definition and treatment of narcissistic personality disorder. The results of systematic studies of narcissistic personality disorder and the characteristics of pathological narcissism have clarified a number of diagnostic issues and precipitated changes in the diagnostic criteria set, but also provoked challenges to narcissistic personality disorder's diagnostic status and its validity as a long-term personality disorder.

Written by a distinguished group of experts who have made important contributions to our understanding in this field, Disorders of Narcissism: Diagnostic, Clinical, and Empirical Implications is the most comprehensive overview of narcissistic pathology and narcissistic disorders to date. Combining the latest empirical evidence, clinical diagnostic observations, and advances in treatment, this volume addresses important subjects at the forefront of the study of narcissism, including cognitive treatment, normal narcissism, pathological narcissism and suicide, and the connection between pathological narcissism, trauma, and alexithymia.

The book is divided into four parts. The authors discuss relevant areas of development in the field, highlight specific theoretical rationales, pinpoint differences in diagnostic and technical approaches to the study of narcissism, and illuminate areas for further clinical and empirical investigation.


  • Foreword.

    Diagnostic and Theoretical Considerations

    . Introduction to Section I. Normal narcissism: an etiological and ethological perspective. Pathological narcissism and narcissistic personality disorder: theoretical background and diagnostic classification. Further developments in the clinical diagnosis of narcissistic personality disorder. The DSM narcissistic personality disorder: historical reflections and future directions. Developmental aspects of normal and pathological narcissism.

    Treatment Implications.

    Introduction to Section II. Transference and countertransference in the treatment of narcissistic patients. Psychoanalysis of patients with primary self-disorder: a self psychological perspective. An object relations theory approach to psychoanalysis with narcissistic patients. Treatment of narcissistic disorders in the intensive psychiatric milieu. Narcissistic patients in group psychotherapy: containing affects in the early group. Schema-focused therapy for narcissistic patients. Manifestations of narcissistic disorders in couples therapy: identification and treatment.

    Special Clinical Considerations.

    Introduction to Section III. Affect regulation and narcissism: trauma, alexithymia, and psychosomatic illness in narcissistic patients. Pathological narcissism and self-regulatory processes in suicidal states.


    Introduction to Section IV. Empirical studies of the construct validity of narcissistic personality disorder. Pathological narcissism: long-term stability and presence in Axis I disorders. Association between psychopathy and narcissism: theoretical views and empirical evidence. Narcissistic personality disorder in adolescent inpatients: a retrospective record review study of descriptive characteristics. Afterword. Index.

About the Authors

Elsa F. Ronningstam, Ph.D., is Assistant Clinical Professor of Psychology at Harvard Medical School, The Psychosocial Research Center at McLean Hospital in Belmont, Massachusetts, and a Candidate at the Boston Psychoanalytic Society and Institute in Boston. She is also Associate Clinical Psychologist at McLean Hospital and at Two Brattle Center in Cambridge, Massachusetts.

If the understanding of narcissistic personality disorder is a work in progress, then Ronningstam's textbook is the most current and meaningful guide to this work. . . . This book is obligatory for those who treat in this field and would be a welcome edition to the libraries of those with a more general practice. Even though much yet remains to be done in the domain of NPD, this book is the current 'gold standard' for this diagnosis. Disorders of Narcissism is therefore highly recommended.—Journal of Psychotherapy Practice and Research

This book is exceptionally clear and approachable. Ronningstam's familiarity with her subject and thoughtful commentary throughout the sections provide continuity and focus for a series of well written, comprehensive chapters. Readers will expand their knowledge of the narcissistic disorders and deepen their understanding of treatment issues, theoretical controversies, and clinical research on this important clinical subject.—Doody's Health Sciences Book Review Journal

This book is a significant achievement and will probably be the primary reference for clinical psychology and psychiatry with regard to the theory and diagnosis of narcissistic personality disorders for many years to come.—Psychoanalytic Books: A Quarterly Journal of Reviews

In this single volume Elsa Ronningstam has done a masterful job of assembling the current thinking of the leading figures in the field. We learn of the relationship of normal to pathological narcissism, subtypes of narcissistic personality disorder, contemporary psychoanalytic notions of narcissism and its treatment, nonpsychoanalytic models of treatment, the relationship of narcissism to trauma and suicide, and the current state of research concerning the validity of the construct, developmental course, and comorbidity with other disorders. The combination of breadth and thorough discussions that are both scholarly and clinically relevant is unusual and refreshing. Reading this volume is like being a privileged guest at a meeting of the people whose work is synonymous with the study of narcissism today. It is a must for anyone who treats, studies, or is interested in narcissistic pathology.—Robert Michels, M.D., Walsh McDermott University Professor of Medicine, Professor of Psychiatry, Cornell University Medical College, New York, New York

Drawing insights from descriptive psychiatry, child and adult psychoanalysis, ethology, infant observation, and rigorous empirical research, Disorders of Narcissism presents a highly informative, lucid, and clinically useful account of pathological self-absorption and its deleterious effects upon capacities for concern, love, work, and morality. . . . Not only does the book address individual psychotherapy and psychoanalysis, it also elucidates the treatment of narcissistic patients in intensive psychiatric milieu, group therapy, schema-focused therapy, and even couples therapy.—Salman Akhtar, M.D., Professor of Psychiatry, Jefferson Medical College, Training and Supervising Analyst, Philadelphia Psychoanalytic Institute, Philadelphia, Pennsylvania

Nearly a century ago, the concept of pathological narcissism entered the psychiatric literature. While psychoanalytic theory has contributed greatly to the understanding of the psychological processes of pathological narcissism, empirical research has more recently been brought to bear on the diagnosis and treatment of these conditions. Disorders of Narcissism provides a very comprehensive review of current knowledge about etiology, construct validity, and treatment, with chapters written by the leading scholars in the field. What is particularly satisfying about the book is its interdisciplinary perspective—conjoining psychodynamic and empirical approaches in a way that sets the standard for understanding disorders of personality.—Joseph T. Coyle, M.D., Eben S. Draper Professor of Psychiatry and of Neuroscience, Chair of the Consolidated Department of Psychiatry, Harvard Medical School, Belmont, Massachusetts

If you work with or are interested in patients with NPD, and desire a deeper understanding of this disorder, this text is an essential read.—Bulletin of the Menninger Clinic

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