Conflicts, defenses and the stability of narcissistic personality features

Abstract

Previous research identified a coherent set of clinical features from the literature, similar to the DSM diagnosis narcissistic personality disorder (NPD). This study tests hypotheses about dynamic conflicts and defenses associated with NPD, and examines the stability of the narcissistic interpersonal style over 2 to 5 years of follow-up. An existing sample of 107 subjects with borderline, antisocial, schizotypal personality and/or bipolar type 2 affective disorder was rated for DSM-III-R NPD, yielding 7 with definite NPD and 27 with significant narcissistic traits. Videotaped dynamic interviews were rated for features of 14 conflicts using the Psychodynamic Conflict Rating Scales (n = 55), and for 22 defenses using the Defense Mechanism Rating Scales (n = 107). Follow-up data on subjects' responses to actual life events were rated for the presence of 6 interpersonal styles (n = 64). NPD features were significantly associated with male gender and antisocial personality. NPD was positively associated with five psychodynamic conflicts (n = 55), including: a) rejection of others, b) ambition-achievement, c) dominant goal, d) resentment over being thwarted by others, and e) counter-dependence; and negatively associated with three conflicts: f) the experience and expression of emotional needs and anger, g) separation-abandonment, and h) dominant other. NPD features were positively associated with four defenses (n = 107) including: a) omnipotence, b) devaluation, c) autistic fantasy, and d) projection, and negatively associated with: e) repression. Finally, over follow-up, NPD was associated with only the narcissistic interpersonal behavioral style (n = 64), demonstrating stability and specificity of the interpersonal behavior in NPD. NPD psychopathology has good convergent, discriminant, and predictive validity in regard to its underlying psychodynamic features and stability of interpersonal behavior over 2 to 5 years. Most of the conflicts and defenses pertain to problems in self-esteem regulation and may serve as foci for treatment.