Episodes
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In this episode, Dr. Ettensohn draws on psychodynamic dimensional models of personality development to describe narcissism and NPD at the borderline level.
Characterized by identity diffusion, blurred boundaries, and disrupted internal experience, borderline personality organization represents an "in between" level where the perceptions of the self and others float in and out of clear focus.
This episode reviews the important concepts of personality style vs. organization, helping the viewer to understand what a personality disorder actually is and why all personality disorders share common features. It discusses the developmental arrests thought to underlie borderline organization and describes common defense mechanisms that characterize this level of object relations. Borderline-level NPD is then discussed using these concepts.
The episode concludes with a discussion of treatment.
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.
Clarkin, J. F., Cain, N. M., & Lenzenweger, M. F. (2018). Advances in transference-focused psychotherapy derived from the study of borderline personality disorder: Clinical insights with a focus mechanism. Current Opinion in Psychology, 21, 80-85. http://dx.doi.org/10.1016/j.copsyc.2017.09.008
Di Giuseppe, M., & Perry, J. C. (2021). The hierarchy of defense mechanisms: Assessing defensive functioning with the Defense Mechanisms Rating Scales Q-Sort. Frontiers in Psychology, 12:718440 https://doi.org/10.3389/fpsyg.2021.718440
Kernberg, O. F. (1970). Factors in the psychoanalytic treatment of narcissistic personalities. Journal of the American Psychoanalytic Association, 18, 51- 85.
Kernberg, O. F. (1984). Severe personality disorders: Psychotherapeutic strategies. New Haven: Yale University Press.
Lingiardi, V., & McWilliams, N. (Eds.). (2017). Psychodynamic diagnostic manual: PDM-2 (2nd ed.). New York: Guilford Press.
McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford Press. Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH
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VISIT THE WEBSITE: https://www.healnpd.org
*A note about the title: The title is a partial quote from BPD specialist Marsha Linehan, describing borderline personality disorder. I am aware of her original intent to describe that specific patient population. I also use the quote in the video to describe the emotional vulnerabilities that necessitate splitting. Although she was describing BPD specifically, I feel the quote also works for borderline organization in general. The intense emotional vulnerabilities and exposure to unprocessed experience reflect the absence of moderating internal capacities - "skin" so to speak.
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Dr. Mark Ettensohn answers questions and responds to viewer comments in a livestream broadcast from 7-25-24.
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Missing episodes?
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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.
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Dr. Mark Ettensohn answers questions and responds to viewer comments in a livestream broadcast from 4-26-24.
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Dr. Ettensohn answers listener questions and responds to comments in a livestream broadcast from 3-14-24.
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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.
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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.
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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.
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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
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In this episode, Dr. Ettensohn discusses the topic of self-awareness in NPD. Numerous commenters have shared their belief that narcissists "know what they are doing"...that they are fully aware of the harm caused by their behaviors. Centering the conversation in the idea of mental illness, Dr. Ettensohn discusses the faulty attributions, skewed perceptions, and interpersonal deficits often associated with pathological narcissism and NPD.
The episode ends with an appeal to viewers to consume reasonable, moderate, nonpolarized perspectives on charged issues like NPD.
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.drettensohn.com/
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In this episode, Dr. Ettensohn outline 4 reasons why empathy may be impaired in pathological narcissism and NPD:
1. Lack of self awareness 2. Objectification of the self and others 3. A 'starvation mindset' 4. Avoidant attachment styles
Dr. Ettensohn also discusses his disagreement with Dr. Ramani's ideas concerning empathy and NPD, as expressed in the following video on her channel: https://youtu.be/O7qxMu3nSLw
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.drettensohn.com/
References: Ettensohn, M. D. (2013). The relational roots of narcissism: Exploring relationships between attachment style, acceptance by parents and peers, and measures of grandiose and vulnerable narcissism. Dissertation Abstracts International: Section B: The Sciences and Engineering, 73(10-B(E)).
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In this episode, Dr. Ettensohn explores the connection between illness anxiety and pathological narcissism. This episode explores how illness anxiety in NPD can be disguised anxiety about loss of self or psychological disintegration.
Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH
LISTEN ON APPLE PODCASTS: https://rb.gy/cklpumLISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpcaLISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8
VISIT THE WEBSITE: https://www.drettensohn.com/
References: Segal, H. (1957). Notes on Symbol Formation. Int. J. Psycho-Anal., 38:391-397
Winnicott, D.W. (1974). Fear of breakdown. International Review of Psycho-analysis, 1: 103-107.
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The term ‘narcissistic abuse’ has been, itself, heavily abused. Is has largely been a pop-psychology term that means different things depending on how and where it is used. It is often used to demonize individuals with pathological narcissism and NPD, who represent an at-risk population for depression, self-harm, and suicide.
In this episode, Dr. Ettensohn provides a new definition for narcissistic abuse - one that is *actually* specific to pathological narcissism and NPD. This new definition is based on the psychodynamics of the disorder itself, and describes an inter-generational chain of emotional mistreatment that creates narcissistic pathology in children, who then grow up to use people in the same way that they, themselves, were used.
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In this episode, Dr. Ettensohn discusses the emptiness that individuals with pathological narcissism and NPD often experience using the concept of ‘Self as Object.’
Individuals with pathological narcissism and NPD often report having been treated as an object for someone else’s gratification in childhood. This early exploitation can cause profound disconnect from emotional authenticity, because it necessitates the development of false self adaptations to protect against overwhelming shame, envy, and rage.
Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life here: https://amzn.to/3nG9FgH
SUBSCRIBE HERE: https://rb.gy/kbhusfLISTEN ON APPLE PODCASTS: https://rb.gy/cklpumLISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpcaLISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8
VISIT THE WEBSITE: https://www.drettensohn.com/
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In this episode, Dr. Ettensohn discusses the relationship between social anxiety and pathological narcissism and NPD, focusing on underlying fears of shame and humiliation, loss of self, and the legacy of relational trauma. The second half of the episode discusses general strategies for addressing social anxiety. References:
Sartre, J.P. (1964). Nausea. New Directions Publishing Corp.
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In this episode, Dr. Ettensohn clarifies the concept of Malignant Narcissism, drawing on the model developed by theorist Otto Kernberg. Common misconceptions are dispelled. Object Relations Theory is used to discuss the origins of both NPD and Malignant Narcissism, highlighting developmental differences between each disorder.
Two meaning of malignant narcissism are discussed:
1. Malignant narcissism is a combination of narcissistic personality, antisocial traits, ego-syntonic sadism, and paranoid thinking that represents its own personality constellation distinct from Narcissistic Personality Disorder.
2. Malignant narcissism represents a phase or episode of narcissistic pathology in which repressed or split-off identifications with sadistic objects rise to the surface and become enacted in relationships. This is often due to loosening of grandiose defenses in psychotherapy.
Link to Episode discussing Borderline Personality Organization referenced in the video: https://youtu.be/ZZP6gAm5L6c
VISIT THE WEBSITE: https://www.drettensohn.com/
BUY THE BOOK: https://amzn.to/3nG9FgH
References:
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).
Goldner-Vukov, M., & Moore, L. J. (2010). Malignant narcissism: From fairy tales to harsh reality. Psychiatria Danubina, 22(3), 392-405.
Kernberg, O. F. (1970). Factors in the psychoanalytic treatment of narcissistic personalities. Journal of the American Psychoanalytic Association, 18, 51-85.
Kernberg O.F. (1984). Severe Personality Disorders. New Haven, CT: Yale University Press
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In this episode, Dr. Ettensohn discusses the topic of integration. Pathological narcissism is a disorder in which different parts of the self are not well-integrated, creating large disparities and discontinuities in identity, self-image, and perception of others. This phenomenon is sometimes called "splitting," and is thought to be partly due to chronic relational trauma and neglect in early childhood. Dr. Ettensohn explains how this occurs and provides suggestions for beginning to approach life more wholistically.
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In this episode, Dr. Ettensohn discusses the importance of recognizing the resiliency of those who struggle with NPD and pathological narcissism. Each person's psychology is a story of survival. In our focus on deficits and pathologies, we often overlook the strength of the individual and the sometimes surprising and ingenious ways that they have found to survive.
References:
Rogers, C. (1980). A way of being. Houghton Mifflin.
Music: www.bensound.com
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In this episode, Dr. Ettensohn addresses common questions about therapy for NPD, discussing the current lack of competent therapists, where to find therapists who understand narcissism, and why it isn't effective to treat NPD on your own.
References:
Blagys, M.D., & Hilsenroth, M.J. (2000). Distincitve activities of short-term psychodynamic-interpersonal psychotherapy: A review of the comparative psychotherapy process literature. Clinical Psychology: Science and Practice, 7, 167-188.
Johnson, S. M. (1987). Humanizing the narcissistic style. New York: W.W. Norton & Co.
Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98-109
Ulberg, R., & Hanne-Sofie, JD. (2018). Empirical support for the psychoanalytic concepts. The Lancet Psychiatry, 5(7), 543-544
Music: www.bensound.com
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