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Author Topic: Narcissistic Personality Disorder: A Current Review by Elsa Ronningstam  (Read 2238 times)

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Offline CZBZ

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    • The Narcissistic Continuum



Narcissistic Personality Disorder: A Current Review

Elsa Ronningstam

Published online: 8 January 2010
# Springer Science+Business Media, LLC 2010


Abstract
The diagnosis of narcissistic personality disorder in the DSM-IV has been criticized foremost for its limitations in capturing the range and complexity of narcissistic pathology. The attention to the narcissistic individual’s external, symptomatic, or social interpersonal patterns—at the expense of his or her internal complexity and individual suffering—has also added to the diagnosis’ low clinical utility and limited guidance for treatment. Recent studies and reviews have pointed to the need for change in the diagnostic approach to and formulation of narcissism. This review focuses specifically on studies of features that add to the identification, understanding, and treatment of patients with pathological narcissistic functioning and narcissistic personality disorder. They have been integrated into a regulatory model that includes the functions and fluctuations of internal control, self-esteem, perfectionism with accompanying selfcriticism, shame, and empathic ability and functioning.


To read this excellent article, click HERE


“The moment a woman comes home to herself, the moment she knows that she has become a person of influence, an artist of her life, a sculptor of her universe, a person with rights and responsibilities who is respected and recognized, the resurrection of the world begins.” ~Joan Chittister

Offline JennyWren

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Re: Narcissistic Personality Disorder: A Current Review by Elsa Ronningstam
« Reply #1 on: August 03, 2011, 04:03:40 AM »
"One study even suggests that people with NPD primarily cause distress and pain in their significant others before facing their own failures and impairment and their accompanying reactions, such as anxiety and depression" - Elsa Ronningstam

Now that`s sounding awfully familiar. Welcome to a my marriage expressed in one sentence!!!!!!!

What a good article. I shall go and read it another 47 times, because it is a bit technical to take in for me first time around.  =thumbs up=

Offline CZBZ

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Re: Narcissistic Personality Disorder: A Current Review by Elsa Ronningstam
« Reply #2 on: August 03, 2011, 06:53:16 PM »
Hi JennyWren!

Here's a reward for tackling complicated literature about the NPD------------------------------------------>  =party=  =rock on= =big grin=

Elsa Ronningstam is the go-to resource for information about NPD. Her book Understanding and Identifying the Narcissistic Personality is the foundation to WoN. No kidding. I bought it in 2005 and have nearly worn it out. Since her studies are often referred to in the literature, I was hoping she'd write a paper about current understanding of NPD since it is changing. Or I should say "Expanding". 

Not to mislead anyone, I read papers like this more than once. Sometimes ten times, putting the ideas contained within, into practical understanding. I have my own 'pet' theories about NPD/pathological narcissism and am really curious to see how things change over the next ten years. For one thing, I think there is (not always in cases of severe trauma/abuse) a biological component. Some researchers argue NO and some say MAYBE and some say YES. I fall into the last category.

In this paper by Ronningstam, she wrote: "two studies have suggested a a genetic influence on the development of NPD, as indicated by a 45-80% heritability. Inherited variations in hypersensitivity, strong aggressive drive, low anxiety or frustration tolerance, and defects in affect regulation are important to the development of NPD."

In my view, it's not irrational to recognize the influence a child might have on the parent. Parenting differs with each child though we try to be fair, we develop a relational pattern with each child's individuality. With a child that is more aggressive, anxious, unable to self-sooth, parents have a challenge on their hands. And that child, the one that is treated differently from other siblings, would harbor negative (unforgiveable) miseries towards his/her parents.

It's one reason why I feel it's so important to help parents with troubled kids. Change the patterns as soon as possible and instead of seeing characterological flaws, see the 'disorder' instead. I wrote a little about that on my blog Aspergers and Boo'ya Moon. Parenting may be able to divert narcissistic traits from becoming pathological, at least that's my hope.

So in reference to your excerpt that "...NPD primarily cause distress and pain in their significant others before facing their own failures and impairment and their accompanying reactions, such as anxiety and depression", I'd say that narcissistic children cause distress and pain in the family-of-origin. What's really sad is that overwrought parents are then blamed completely by the narcissistic child without looking at the child's impossible behavior. Most people aren't equipped to deal with a little narcissist and resort to authoritarian even Draconian tactics to manage the kid. OR, they give up. Let the kid do whatever the heck he or she wants 'cuz they can't deal with the struggle.

Just a few more thoughts and a big, fat opinion. ha!

Hugs,
CZ
“The moment a woman comes home to herself, the moment she knows that she has become a person of influence, an artist of her life, a sculptor of her universe, a person with rights and responsibilities who is respected and recognized, the resurrection of the world begins.” ~Joan Chittister

Offline JennyWren

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Re: Narcissistic Personality Disorder: A Current Review by Elsa Ronningstam
« Reply #3 on: August 04, 2011, 03:46:11 AM »
Oh crumbs CZ....this has all got my thinking on ultra-high-thought-density mode. I will try not to go on and on and on like the Duracell Bunny.

Firstly your blog....what an absolute delight to read! Your instinctive acceptance of individuality is just perfect. And in your acceptance of your nephew for who he is...rather than trying to make him conform to what "society" dictates he must be, you created an environment for your wonderful and unique nephew to flourish and become all that he is in total fullness. You have given him the love and support to develop as he should. And embracing the child they are...and adult they become  should be every parents primary aim.

Because little humans are all so different. Right from birth in my opinion. I was very aware of it in my daughters. One needed so much more comforting than the other from the word go. I had mastered one baby....when the second one came along...in my stupidity, I thought I knew all about babies and how to look after them, to sooth and comfort them. Wrong. My second daughter responded totally differently to life...and I felt very quickly as though I was having to learn all over again.

So I totally agree that in all of us there is at the very least an element of genetic predisposition to certain character traits. I suspect that actually a great deal of "what we are" is down to our predetermined nature. Of course the influence of our environment must mould our personalities from the very beginnings of consciousness. And studies of identical twins would illustrate that.

So now to thinking about the way children are parented....the nature of the parents personality is going to have a HUGE influence over parenting style. (This is a subject very close to my heart....since my own parenting style was viciously attacked and degraded by my NH and his NFOO) A child who is naturally anxious, for example, in the parenting hands of someone with no empathy or time for anxiousness, will not become comfortable with themselves and have to deal with their feelings alone. An autistic child ( I also have an autistic nephew..now 12 years old) whose ways are not acknowledged will likely become a fairly permanent inhabitant of Boo`ya moon. (What a lovely gentle description of his experience)

And now thinking of Nparents. Aaaaaargh! yuck yuck yuck. I have to say that even with cast iron solid non-N genetics, the experience of Nparents and their complete lack of empathy and ability to consider the well-being of anything that is not them is going to be a most profoundly difficult experience. If parenting should create an environment for an individual to be unconditionally loved and accepted...this is what Ns try their darndest to NOT do.

My NH and his NFOO told me continually in no uncertain terms what a useless parent I was because, in their view, I lacked "discipline". Discipline to them means that when a tiny baby cries, you leave it to sort itself out. You are teaching it to be self-disciplined and quit bugging you.  Discipline means that when the Ngranny makes a fish soup so revolting and teaming with slimy sea life that it made ME want to run from the room screaming....the 5 and 6 year old cousins will be fed same from a spoon by the enabling wives (NOT ME!!!!) until they are physically sick....as apparently discipline just means "doing as I say whether it is completely insensitive or not....I will impose my will"

Well, I would have no part of that. If my daughter cried I held and comforted her. If she didn`t want to play with the NFOO cousins she was welcome to cower on my knee. And I was so horribly victimised as a result. I was creating "issues" in my daughter by "wrapping her in cotton wool". It was early days in the NFOO for me back then....and I tried to point out that in fact they were creating issues by not letting her be herself. Oooops! A big mistake.  =i dont want to see=

So taking into account the enormous differences in parenting styles generally...even before you add the terrible Nparents into the mix....it stands to reason that the development of psychological disorders has its roots in a very complex set of criteria. Nature and nurture combining in any number of different blends....producing infinite outcomes as each set of genetics and circumstances interact over the course of a lifetime. and each outcome is probably unique.

Which (sorry CZ...I am still going...!!! =big grin=) brings me to another point that has been crystallising in my mind of late. The whole classification of NPD and other disorders bothers me. Seems to me (understandably) that there is an emphasis on putting disordered people into boxes and giving them labels because it is so nice to give worrying things a name. Comforting to pretend that the label itself is somehow a beginning of a solution. But the disorders are wholly categorised by their SYMPTOMS. An N will present differently to a B. We can observe their behaviour and say "Yes....he is an N because he does such and such"...and to a certain extent there are explanations of why they do such and such.

But for me....I am wondering if it might not be better to think about what is happening in the person to cause the symptoms. What I am wondering is if the same problems are the root cause of very different symptoms in very differnet people. That a certain problem in psychology....or even in the brain might present as an N in one individual...and a B in another for example. Of course I am not limiting this idea to Ns and Bs....but perhaps they are a good example. Especially because there is a greater predominance of female Bs and male Ns....which might suggest that individuals are expressing the same set of brain functioning issues differently. Add to this the complex nature of brain functioning (as demonstrated very well by the complex subject of neurotransmitter biochemistry as discussed in the lecture concerning depression by Robert Sapolsky you posted the other day)....and one could easily see how one specific innate disfunction...or set of dysfunctions of the brain due to genetics could lead to multiple outcomes in behaviour as individuals learn to deal with the different environments they inhabit.

I am not saying this very well. And I suspect that psychologists are way ahead of me here anyhow. I guess I am wondering if there is not a little too much emphasis at looking at the multitudinous different types and subtypes of behaviours and how different they are, rather than understanding the commonality of what has gone on in their heads to cause the behaviours.

Having seen how commonly some Ns behave in minute detail in some ways would suggest to me that there is a fundamental commonality to their brain function that can not be explained by environment. If an NH in the UK is saying the same things in the same damned words as his counterparts in the US and Australia and everywhere on the planet....it could originate from the same psychological flaw or brain disfunction. For example..NS common strange use of language is significant to me in suggesting an actual structural brain issue.

Aaaaaarghhh...see what happens when I read too much. Hush now JW....and go and wash the dishes!!!
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