In this episode, Dr. Ettensohn draws on psychodynamic dimensional models of personality development to describe narcissism and NPD at the psychotic level.

Characterized by compromised reality testing, symbiotic object relations, low integration between parts of the self, and the use of reality-distorting defense mechanisms, psychotic-level NPD represents both the least developmentally mature and most severe form of the disorder.

This episode explains the spectrum of personality development, from psychotic to healthy. It then explains the psychotic personality organization in detail, providing descriptions of specific defense mechanisms utilized at this level. Finally, psychotic-level NPD is described.

Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH

LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8

VISIT THE WEBSITE: https://www.healnpd.org

Cited References:

Berney, S., de Roten, Y., Beretta, V., Kramer, U., & Despland, J.-N. (2014). Identifying psychotic defenses in a clinical interview. Journal of Clinical Psychology, 70(5), 428–439.

Kernberg, O. F. (1984). Severe personality disorders: Psychotherapeutic strategies. New Haven: Yale University Press.

McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford Press.

Dr. Ettensohn answers listener questions and responds to comments in a livestream broadcast from 3-14-24.

This episode is the audio from an on-camera interview between licensed psychotherapist Lisa Taylor-Austin and Dr. Ettensohn. The video of this interview can be viewed on Lisa's youTube channel here: https://www.youtube.com/@LisaTaylor-Austin

This audio recording is posted with Lisa's permission. This discussion covers numerous topics, from treating pathological narcissism, the diagnostic criteria for NPD, variation in narcissistic pathologies between siblings raised in the same family system, the use of defenses like splitting, and the ever-present stigma surrounding NPD.

Lisa runs the Taylor-Austin Group. Learn more at their website: https://thetayloraustingroup.com/

In this episode, Dr. Ettensohn draws heavily on his own research concerning pathological narcissism and attachment patterns, using attachment theory as a lens to focus explanatory power onto the often confusing dynamics of NPD.

Beginning with a general overview of Bartholomew's four-prototype model of adult attachment, Dr. Ettensohn identifies the most common attachment patterns of individuals with NPD. He describes the relevant research on the development of these patterns and draws parallels with descriptions of early care deficits thought to cause pathological narcissism.

Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH

SUBSCRIBE HERE: https://rb.gy/kbhusf

LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8

VISIT THE WEBSITE: https://www.healnpd.org

Cited References: Bartholomew, K. (1990). Avoidance of intimacy: An attachment perspective. Journal of Social and Personal Relationships, 7(2), 147-178.

Bartholomew. K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61(2), 226-244.

Bennett, C. S. (2006). Attachment theory and research applied to the conceptualization and treatment of pathological narcissism. Clinical Social Work Journal, 34(1), 45-60.

Blatt, S. J., & Levy, K. N. (2003). Attachment theory, psychoanalysis, personality development, and psychopathology. Psychoanalytic Inquiry, 23, 104-152.

Bowlby, J. (1973). Attachment and loss: Volume 2: Separation. New York: Basic Books.

Connors, M. E. (1997). The renunciation of love: Dismissive attachment and its treatment. Psychoanalytic Psychology, 14, 475-493.

Dickinson, K. A., & Pincus, A. L. (2003). Interpersonal analysis of grandiose and vulnerable narcissism. Journal of Personality Disorders, 17(3), 188-207.

Ettensohn, M.D. (2011). The relational roots of narcissism: Exploring relationships between attachment style, acceptance by parents and peers, and measures of grandiose and vulnerable narcissism. (Doctoral dissertation). Retrieved from Dissertations and Theses: Full Text. (Publicaiton No. AAT 3515488).

Gabbard, G.O. (1989). Two subtypes of narcissistic personality disorder. Bulletin of the Menninger Clinic, 53, 527-532.

Holdren, M. (2004). Causal attributions among overt and covert narcissism subtypes for hypothetical, retrospective, and prospective events. (Doctoral dissertation). Retrieved from Dissertations & Theses: Full Text. (Publication No. AAT 3146467).

Kernberg, O. F. (1970). Factors in the psychoanalytic treatment of narcissistic personalities. Journal of the American Psychoanalytic Association, 18, 51-85.

Kobak, R. R., & Sceery, A. (1988). Attachment in late adolescence: Working models, affect regulation, and representations of self and others. Child Development, 59, 135-146.

Main, M., & Stadtman, J. (1981). Infant response to rejection of physical contact by the mother. Journal of the American Academy of child Psychiatry, 20, 292-307.

Otway, L.J., Vignoles, V.L. (2006). Narcissism and childhood recollections: A quantitative test of psychoanalytic predictions. Personality and Social Psychology Bulletin, 32(1), 104-1116.

Pistole, C. M. (1995). Adult attachment style and narcissistic vulnerability. Psychoanalytic Psychology, 12(1), 115-126.

Scroufe, L. A., Waters, E. (1977). Heart rate as a convergent measure in clinical and developmental research. Merrill Palmer Quarterly, 23, 3-25.

Smolewska, K., & Dion, K. L. (2005). Narcissism and adult attachment: A multivariate approach. Self and Identity, 4, 59-68.

In this episode, Dr. Ettensohn addresses 5 common misconceptions about pathological narcissism and NPD:

1. NPD is not a mental illness

2. NPD is not treatable

3. Even if NPD is treatable, actual healing is impossible

4. All individuals with NPD are abusers

5. People with NPD change their behavior behind closed doors, so they can't be mentally ill

Using authoritative mental health resources like the American Psychiatric Association, American Psychological Association, National Institutes of Health, and the Domestic Abuse Hotline; as well as reference to peer-reviewed literature, Dr. Ettensohn discusses each of these misconceptions and why they are mistaken.

Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH

VISIT THE WEBSITE: https://www.drettensohn.com/

Cited References:

Alexander. (n.d.). Abuse and mental illness: Is there a connection? National Domestic Violence Hotline. https://www.thehotline.org/resources/abuse-and-mental-illness-is-there-a-connection/

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C.: American Psychiatric Association.

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text revision). Washington, D.C.: American Psychiatric Association.

American Psychiatric Association. (n.d.). What is mental illness? https://www.psychiatry.org/patients-families/what-is-mental-illness

American Psychological Association. (n.d.). Splitting. APA Dictionary of Psychology. https://dictionary.apa.org/splitting

Cooper, A. M., & Michels, R. (1988). [Review of Diagnostic and statistical manual of mental disorders (3rd ed., rev.)]. American Journal of Psychiatry, 145, 1300-1301.

Freud, S. (1914). On narcissism. SE, 14, 67-102. London: The Hogarth Press.

National Institutes of Health. (n.d.). Information about mental illness and the brain. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK20369/

Ronningstam, E. & Weinberg, I. (2013). Narcissistic personality disorder: Progress in recognition and treatment. Focus: The Journal of Lifelong Learning in Psychiatry, 11(2), 167-177.

In this episode, Dr. Ettensohn discusses the important topic of boundaries. He provides a definition of interpersonal boundaries, discusses the reasons why boundaries are important for mental health and healthy relationships, discusses the problems with boundaries that often occur in pathological narcissism and NPD, and provides some basic tips for assertive behavior.

Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH

References:

Hörz-Sagstetter, S., Caligor, E., Preti, E., Stern, B. L., De Panfilis, C., & Clarkin, J. F. (2017). Clinician-Guided Assessment of Personality Using the Structural Interview and the Structured Interview of Personality Organization (STIPO). Journal of Personality Assessment, 100(1), 30–42.

Lingiardi, V., & McWilliams, N. (Eds.). (2017). Psychodynamic diagnostic manual: PDM-2 (2nd ed.). The Guilford Press.

Mahler, M. S. (1972). Rapprochement subphase of the separation-individuation process. The Psychoanalytic Quarterly, 41(4), 487–506.

In this episode, Dr. Ettensohn explores the possible causes of narcissistic rage, referencing the work of Ernest S. Wolf, a close collaborator with Heinz Kohut and author of the book 'Treating the Self: Elements of Clinical Self Psychology."

Dr. Ettensohn discusses the ways in narcissistic rage functions as a defense of the unbearably wounded self and results from implicit confusion between self and other rooted in traumatic early experiences of helplessness, humiliation, and shame.

References:

Crisp, H., & Gabbard, G. O. (2020). Principles of psychodynamic treatment for patients with narcissistic personality disorder. Journal of Personality Disorders, 34 (Special Issue), 143-158.

Pincus, A.L., Ansell, E.B., Pimentel, C.A., Cain, N.M., Wright, A.G.C., & Levy, K.N. (2009). Initial construction and validation of the Pathological Narcissism Inventory. Psychological Assessment, 21, 365-79.

Ruiz, M. (2001). The four agreements: A practical guide to personal freedom. Amber-Allen Publishing.

Wolf, E.S. (1988). Treating the self: Elements of clinical self psychology. New York: The Guilford Press