Kacel Elizabeth L, Ennis Nicole, Pereira Deidre B
a Department of Clinical and Health Psychology , University of Florida.
Behav Med. 2017 Jul-Sep;43(3):156-164. doi: 10.1080/08964289.2017.1301875.
Narcissistic Personality Disorder (NPD) is characterized by a persistent pattern of grandiosity, fantasies of unlimited power or importance, and the need for admiration or special treatment. Individuals with NPD may experience significant psychological distress related to interpersonal conflict and functional impairment. Research suggests core features of the disorder are associated with poor prognosis in therapy, including slow progress to behavioral change, premature patient-initiated termination, and negative therapeutic alliance. The current manuscript will explore challenges of working with NPD within the context of life-limiting illness for two psychotherapy patients seen in a behavioral health clinic at a large academic health science center. The ways in which their personality disorder affected their illness-experience shared significant overlap characterized by resistance to psychotherapeutic change, inconsistent adherence to medical recommendations, and volatile relationships with providers. In this manuscript we will (1) explore the ways in which aspects of narcissistic personality disorder impacted the patients' physical health, emotional well-being, and healthcare utilization; (2) describe psychotherapeutic methods that may be useful for optimizing psychosocial, behavioral, and physical well-being in individuals with co-morbid NPD and life-limiting disease; and (3) review conceptualizations of NPD from the DSM-5 alternative model for assessing personality function via trait domains.
自恋型人格障碍（NPD）的特征是一种持续存在的浮夸模式、对无限权力或重要性的幻想，以及对赞赏或特殊待遇的需求。患有NPD的个体可能会因人际冲突和功能损害而经历严重的心理困扰。研究表明，该障碍的核心特征与治疗预后不良有关，包括行为改变进展缓慢、患者过早主动终止治疗以及消极的治疗联盟。本手稿将探讨在一家大型学术健康科学中心的行为健康诊所中，针对两名患有终末期疾病的心理治疗患者，在终末期疾病背景下治疗NPD所面临的挑战。他们的人格障碍影响其疾病体验的方式存在显著重叠，表现为对心理治疗改变的抗拒、对医疗建议的不一致依从性以及与医护人员的不稳定关系。在本手稿中，我们将（1）探讨自恋型人格障碍的各个方面如何影响患者的身体健康、情绪健康和医疗保健利用；（2）描述可能有助于优化患有共病NPD和终末期疾病个体的心理社会、行为和身体健康的心理治疗方法；（3）回顾《精神疾病诊断与统计手册》第五版（DSM - 5）通过特质领域评估人格功能的替代模型中对NPD的概念化。
