THE DEPENDENT SELF IN NARCISSISTIC PERSONALITY DISORDER IN COMPARISON TO DEPENDENT PERSONALITY DISORDER: A DIALOGICAL ANALYSIS (2/2)

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created by theconstellinguist on 18/11/2024 at 10:53 UTC*

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Salvatore, G., Carcione, A., & Dimaggio, G. (2012). The dependent self in narcissistic personality disorder in comparison to dependent personality disorder: A dialogical analysis. *International Journal for Dialogical Science*, *6*(1), 31-49.

1: http://www.sakkyndig.com/psykologi/artvit/salvatore2012.pdf

2: http://www.sakkyndig.com/psykologi/artvit/salvatore2012.pdf

3: https://narcissismresearch.miraheze.org/wiki/AIReactiveCodependencyRageDisclaimer

4: https://narcissismresearch.miraheze.org/wiki/AIReactiveCodependencyRageDisclaimer

1. In normal individuals an activation of the attachment system surfaces in consciousness in the form of appropriate emotions, e.g. weakness or a need for consolation. With the activation of attachment narcissists instead appear cold, tense and self-reliant and are not consciously aware of any emotions connected with their need for attention (Bowlby, 1988; Jellema, 2000). It is difficult for the “Vulnerable Child” (Young, Klosko & Weishaar, 2003) self-aspect to surface in consciousness. As a result, when looking for support, the self paradoxically appears to be self-reliant. The pattern most likely to emerge is self-reliant self/distant and indifferent other (Dimaggio et al., 2002).

1. Our goal is to achieve a refined NPD pathology and treatment model, in which silently expecting admiration from others (Kohut, 1971) and showing symptoms or interpersonal malfunctioning when such a support is lacking (Dimaggio, Semerari, Carcione, Nicolò & Procacci, 2007; Robins & Beer, 2001) are generally a form of unhealthy dependency and should be given a special emphasis in treatment, even more than challenging the classic grandiose self features (see Dimaggio, Salvatore, Nicolò, Fiore & Procacci, 2010a).

1. Dialogical self therapy is the proscribed tool for those who show these concerning intersections of narcissism and dependent personality disorder.

1. Psychological health and social adaptation can depend on (a) the existence of a sufficient variety of voices, i.e. a minimum degree of self-multiplicity — persons need many voices in order to deal with the host of problems arising in a demanding and ever changing society; (b) the ability to be aware of one’s many self aspects; (c) the ability of the different voices to engage in a dialogue involving mutual recognition, negotiation of conflicts and openness to innovation— the voices need to be reciprocally aware of each other’s perspectives and able to engage in a dialogue respecting their differences; (d) the creation of superordinate points of view, called meta-positions (Hermans, 2001) or metacognitive integration (Semerari, Carcione, Dimaggio, et al., 2003), which provide a sense of coherence, coordinate the different self-aspects and make it possible to solve conflicts and find new and more effective solutions (see Dimaggio, Hermans & Lysaker, 2010b for associations between problems in self-multiplicity and psychopathology).

1. One key difference is in the desired and feared dialogical interaction patterns underlying the two disorders. While in DPD the desired pattern can be schematised as vital self v. close, loving and attentive other and the feared pattern as abandoned and devitalised self v. distant, inattentive and unavailable other, in NPD the desired pattern can be schematised as effective and admired self v. admiring other, while the feared one is self seeking admiration v. other denying attention and support, causing the self to fall into a state with poor-self-efficacy, lack of agency (Dimaggio, in press), action paralysis and sense of emptiness.

1. Moreover, when NPD sufferers face real-life setbacks, in particular abandonment by a romantic partner, they enter states in which they seek attention from another. However the latter is however perceived as ineffective and they react by assuming a defeatist stance. DPD sufferers, instead, cling desperately to their caregivers in the expectation of receiving help.

1. Paul is a 36-year-old patient meeting NPD criteria. He has a postgraduate doctor’s degree and intends to pursue a university career. He seeks therapy because of frequent panic attacks and a chronic sense of depressive emptiness. In the early stages of his therapy his narratives – featuring a typical narcissistic narrative style, i.e. detached and intellectualising (Dimaggio et al., 2007; 2010a) – are entirely about his romantic involvement with an ex-student (he taught Italian for a short period in a language school for foreign students), which she has recently broken off. The dynamics of the relationship are of special note: Paul searches for the other and projects a disinterested, friendly self-image of himself; when she accepts his proposal and engages in the relationship on this basis, he looks for more proximity and intimacy and becomes angry and demanding when she does not satisfy his romantic requests; at this point she disengages from the relationship and he starts to search for her in a highly aroused state, in the end offering again his disinterested help like a friend. The cycle restarts.

1. In this description Paul displays some of the behavior typical of unhealthy dependency (Bornstein, 2005), like strong desire for support, relationship-facilitating self-presentation strategies to strengthen ties with significant others, and an urgent and often angry and vindictive seeking of the other when there is the threat of being abandoned. During the first few sessions Paul provides a perspicacious description of his feelings of unhealthy dependency:

1. “Maybe every time I’ve got interested in a girl I’ve tried to adapt myself to that person without really being myself […] I believe it depends entirely on a question of self-esteem because you always try to be acknowledged by the other and so in a way you try to understand what the other wants and to adapt yourself to that desire […]” We maintain that this description contains the essence of pathological dependency in narcissists: the other’s importance is regulated by the pressing need for the other to acknowledge one’s personal worth. In DST terms the desired self-position is effective, admired self v. admiring other.

1. This dialogical pattern takes on various nuances in line with swings in self-esteem, regulated in their turn by outside events. If their self-esteem is based on negative values, NP disordered patients fall into a depressive state (Dimaggio & Stiles, 2007; Dimaggio et al., 2007), in which they are seized by a pervasive awareness that their grandiose image has collapsed. In this instance the presence of an admiring other has the function of removing the feared representation of an ineffective and failed Self. In this mental state patients are likely to pressingly seek the other and – like Paul – become angry and vindictive if the latter backs off, thus confirming their negative self-perception. In this case they are in the feared self-position, i.e. ineffective and failed self v. other confirming failure by not providing attention.

1. Let’s say, if I’ve understood correctly, Claire becomes less important for you at the moment at which you feel closer to a position of strength and prestige. We also have to include here that you had a strong impulse to let Claire know you were reaching this position of prestige. Then, immediately afterwards, you felt your movements in the relationship could be freer, to the extent that you were also expressing more critical thoughts about it […], about Claire’s negative characteristics. So maybe […] one could think that among the fundamental impulses behind your relationship with Claire is that of being acknowledged, having the feeling that the other can see your worth… Pt.: (long pause) Yes, there could be… (pause) and does my father have something to do with this? Because on one occasion I noticed… that when I don’t feel acknowledged I become like a child [..].

1. The state is linked in NPD to a lack of events capable of feeding the grandiose selfimage; for example, after the joy for an earlier success has deflated and self-esteem is again open to discussion (Dimaggio et al., 2002). In this state the lack of preferential attention from the other can confirm an image of self as a failure and precipitate an outand-out depressive state. In such states patients become dysphoric defeatists and, albeit continuing with their therapy, take a contemptuous attitude and deny their therapist can help them in any way.

1. In both disorders unhealthy dependency can manifest itself with periods of vindictive rage towards the significant other. In narcissists the rage is a transition state (Dimaggio et al., 2002), which gets activated when they see others as rejecting or hindering their goals, and serves to avoid the shift towards the empty depressive state, in which, instead of blaming others, narcissists collapse under their own perception of limited personal worth

1. https://ibb.co/s66QBYv[5][6]

5: https://ibb.co/s66QBYv

6: https://ibb.co/s66QBYv

1. In our narcissistic patient the path taken by the anger seems decoupled from relationship events and can go in two directions: towards either the empty depressive state if the subject consciously perceives his failure and this causes a collapse in his grandiose self-image, or the joyful state, if an outside event reinforces his self-esteem and restores the self-image.

1. In this work we have focused on the unhealthy dependency trait in NPD. This trait is not contemplated by the nosography, while recent literature on this PD analyses it much less than grandiosity. We have performed a phenomenological analysis of unhealthy dependency in NPD in the light of the DST and through a comparison with unhealthy dependency in DPD. NPD Patients invest in their relationships with others to defend their grandiose self-image when this is threatened or to preserve and expand it when not threatened. In other words, narcissistic patients do not depend on others like dependent ones do, but need other’s approval and admiration, most of all when there is a risk of approval and admiration by the world disappearing.

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