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Narcissism and Depression Personality Pathology, Psychological Factors and Pattern of Depressive Symptoms in Patients with Narcissistic Disturbances

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Narcissism and Depression Personality Pathology, Psychological Factors and Pattern of Depressive Symptoms in Patients with Narcissistic Disturbances UNIVERSITY OF COPENH AGEN FACULTY OF HEALTH AND MEDICAL S CIENCES REGION ZEALAND CLINIC FOR NON - PSY CHOTIC DISORDERS SLA GELSE AND HOLBÆK PSYCHIATRIC RESEARCH UNIT Narcissism and Depression Personality Pathology, Psychological Factors and Pattern of Depressive Symptoms in Patients with Narcissistic Disturbances PhD Thesis Jane Fjermestad-Noll PhD- Student Jane Fjermestad-Noll, MD Clinic for Non-Psychotic Disorders, Slagelse and Holbæk Psychiatric Research Unit, Region Zealand Faculty of Health and Medical Sciences, Graduate Programme in Clinical Research University of Copenhagen Supervisor: Erik Simonsen Submitted to the Graduate School of Health and Medical Sciences University of Copenhagen 25th of April 2019 Principal Supervisor Professor Erik Simonsen, MD, PhD, Dr.h.c. Psychiatric Research Unit, Copenhagen University Hospital, Slagelse, Region Zealand Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen Project supervisor Adj. Professor Bent Rosenbaum, MD Institute of Psychology, University of Copenhagen International Supervisor, Academic Advisor Associate Professor Elsa Ronningstam, PhD Harvard Medical School, McLean Hospital Co-supervisor Bo Bach, PhD Center for Personality Disorder Research Psychiatric Research Unit, Copenhagen University Hospital, Slagelse, Region Zealand Review Committee Professor Annamaria Giraldi, MD, PhD Department of Clinical Medicine, University of Copenhagen Professor Sigmund Karterud, MD, PhD, Universitetet i Oslo Professor Bo Møhl, PhD, The Faculty of Humanities, Department of Communication and Psychology, Aalborg University Submitted 25.04.2019 3 ”Here, Narcissus arrived, all hot and exhausted from hunting, and sank to the ground. The place looked pleasant, and here was a spring! Thirsty for water, he started to drink, but soon grew thirsty for something else. His being was suddenly overwhelmed by a vision of beauty. He fell in love with an empty hope, a shadow mistaken for substance. He gazed at himself in amazement, limbs and expression as still as a statue of Párian marble. Stretched on the grass, he saw twin stars, his own two eyes, rippling curls like the locks of a god, Apollo or Bacchus, cheeks as smooth as silk, an ivory neck and glorious face with a mixture of blushing red and creamy whiteness. All that his lovers adored, he worshipped in self-adoration. Blindly rapt with desire for himself, he was votary and idol, suitor and sweetheart, taper and fire- at one and the same time. Those beautiful lips would implore a kiss, but as he bent forward the pool would always betray him. He plunges his arms in the water to clasp that ivory neck and finds himself clutching at no one.” Narcissus and Echo, Metamorphoses, Ovid 4 Acknowledgements First, I would like to thank all the participants for investing the time and effort, in completing the self-report surveys and participating in the clinical interviews. I would like to thank the directors of Region Zealand Psychiatry, and the leaders of Psykiatrien Vest and the Psychiatric Research Unit, for making the study possible. In particular I would like to thank Erik Simonsen, for believing in my initial idea, for supporting the process of outlining the frame of the study and the terms of employment, hence making the investigation possible. Furthermore, I would like to express my gratitude for his sharing of knowledge and for introducing me to his large network of relevant clinicians and researchers, both nationally and internationally. Lastly, I would like to thank “Simon” for appreciating my stubbornness in wishing to complete the study. I would like to thank Bent Rosenbaum for inspiring and stimulating my interest for research in this field, and to follow me through the process of establishing the project, and being willing to act as project supervisor. Bent is a well of knowledge and is always pouring generously from his inexhaustible source of wisdom and experience. Thank you for sharing your enthusiasm and optimism, and always offering academic and diplomatic advice. I would like to thank Bo Bach for his tremendous support as a supervisor. Without his kind and gentle guidance, I might still be stuck in the library looking for the right book to reveal the mysteries of statistics. Thank you, Bo, for always spreading your contagious humor and zest for research, in our immediate environment. I would like to express my immense gratitude to Elsa Ronningstam, for generously offering her academic advice and sharing her tremendous clinical knowledge of narcissism. Elsa has enthusiastically invited me to participate in, and observe her clinical work, during my three visits to MacLean Hospital, Cambridge, MA. I would particularly like to thank her for demonstrating how her positive and forthcoming nature, makes the treatment of these patients feasible. Lastly, I am indebted to her for taking great care of me during my visits, for introducing me, and arranging meetings, with a number of relevant researchers. Also, for inviting me to many interesting lectures and workshops in her Psychoanalytic network. I would like to thank those who have offered inspirational conversations and email correspondences, during the time of conceptualizing and outlining of the project: Otto Kernberg, Theodore Millon, Per Bech, Terry Maltsberger, John Gunderson, Aaron Pincus, Sydney Blatt, Stephen Huprich, Mary Zanarini, Arielle Baskin-Summer and Igor Weinberg. I would like to thank Lise Møller and Maria Meisner for the inspiring cooperation, and supportive talks. I would like to thank the entire staff at the Psychiatric Research Unit, Psykiatrisk Klinik Holbæk and Slagelse, especially the always smiling and utterly competent and welcoming, research librarian Trine Lacoppidan Kæstel, but also Dorit Mortensen, Ole Jacob Storebø, Lene Halling, Mickey Kongerslev, Sune Bo, Mathias Skjernov, Hanne Larsen, Lars Neisig Møller, Benedikte Wermuth, Lotte Dragsted, Maria Jacobsen, Birthe Jarlfeldt, Stine Thorning, Anette Svendsen, Andrei Trubach, Michael Schmidt and Gunnar Laier. Lastly, I would like to thank my friends and family for supporting me during the process, absorbing frustrations and offering positive encouragement. 5 Table of contents ACKNOWLEDGEMENTS ......................................................................................... 5 TABLE OF CONTENTS ............................................................................................ 6 PREFACE................................................................................................................ 10 FUNDING ................................................................................................................ 10 GUIDE TO READING THE THESIS ........................................................................ 11 LIST OF PAPERS ................................................................................................... 12 LIST OF ILLUSTRATIONS ..................................................................................... 12 LIST OF TABLES .................................................................................................... 13 LIST OF ABBREVIATIONS .................................................................................... 13 INTRODUCTION ..................................................................................................... 14 AIMS OF THE STUDY ............................................................................................ 14 1. BACKGROUND .................................................................................................. 15 1.1 Historical Background ................................................................................................................................ 15 1.2 Theories on Origin and Presentation of Narcissistic Pathology .............................................................. 15 1.2.1 Heinz Kohut (1913-1981) ..................................................................................................................... 15 1.2.2 Otto Kernberg (1928-) ........................................................................................................................... 17 1.2.3 Theodore Millon (1928-2014) ............................................................................................................... 18 1.2.4 Clinical phenotypes of Narcissistic Pathology ...................................................................................... 19 1.2.4a The nature of narcissism ...................................................................................................................... 19 1.2.4b Phenotypes of narcissism .................................................................................................................... 20 1.2.4c Expressions of narcissism .................................................................................................................... 23 1.2.4d Structure of narcissism ........................................................................................................................ 23 1.2.5 Clinical presentation of narcissism according to Ronningstam ............................................................. 24 1.3 Self-report measures of Narcissistic Pathology ........................................................................................ 25 1.3.1 Narcissistic Personality Inventory and Pathological Narcissism Inventory .......................................... 25 1.4 Diagnostic Considerations .........................................................................................................................
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