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Cited by 72Personality Disorders and PsychopathologyPsychoanalysis and Psychopathology ResearchPersonality Traits and Psychology

Attachment and mentalization in female patients with comorbid narcissistic and borderline personality disorder.

Diamond, Diana, Levy, Kenneth N., Clarkin, John F., Fischer-Kern, Melitta, Cain, Nicole M., Doering, Stephan, Hörz, Susanne, Buchheim, Anna·2014·Personality Disorders: Theory, Research, and Treatment
DOI 10.1037/per0000065
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Abstract

We investigated attachment representations and the capacity for mentalization in a sample of adult female borderline patients with and without comorbid narcissistic personality disorder (NPD). Participants were 22 borderline patients diagnosed with comorbid NPD (NPD/BPD) and 129 BPD patients without NPD (BPD) from 2 randomized clinical trials. Attachment and mentalization were assessed on the Adult Attachment Interview (AAI; George, Kaplan, & Main, 1996). Results showed that as expected, compared with the BPD group, the NPD/BPD group was significantly more likely to be categorized as either dismissing or cannot classify on the AAI, whereas the BPD group was more likely to be classified as either preoccupied or unresolved for loss and abuse than was the NPD/BPD group. Both groups of patients scored low on mentalizing, and there were no significant differences between the groups, indicating that both NPD/BPD and BPD individuals showed deficits in this capacity. The clinical implications of the group differences in AAI classification are discussed with a focus on how understanding the attachment representations of NPD/BPD patients helps to illuminate their complex, contradictory mental states.

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  • Studies have documented preoccupied, dismissive, or not-possible-to-classify attachment patterns in NPD, implicating representations of self and others as underpinnings of the disorder and the associated interpersonal style.

    “Studies (46, 47) have documented preoccupied, dismissive, or not-possible-to-classify attachment patterns, implicating representations of self and others as underpinnings of the disorder and the associated interpersonal style.”

    From Narcissistic Personality Disorder: Progress in Understanding and Treatment (2022) · cites this paper as [46]

  • Existing studies have found individuals with NPD to have similar mentalizing deficits to those found in BPD.

    “Although studies on narcissism and reflective-functioning are sparse, existing studies have found individuals with NPD to have similar mentalizing deficits to those found in BPD (e.g. [20].”

    From “It’s not you, it’s me”: identity disturbance as the main contributor to interpersonal problems in pathological narcissism (2023) · cites this paper as [20]

  • Patients with comorbid narcissistic and borderline personality disorder scored low on mentalizing.

    “Diamond and colleagues showed that patients with comorbid narcissistic and borderline personality disorder scored low on mentalizing [25].”

    From Symptom severity and mindreading in narcissistic personality disorder. (2018) · cites this paper as [25]

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Authors
Diamond, D., Levy, K. N., Clarkin, J. F., Fischer-Kern, M., Cain, N. M., Doering, S., Hörz, S., & Buchheim, A.
Affiliations
  • City University of New York (US)
  • Pennsylvania State University (US)
  • Weill Cornell Medicine (US)
  • Long Island University (US)
  • Medical University of Vienna (AT)
  • Universität Innsbruck (AT)
ORCID
Venue
Personality Disorders: Theory, Research, and Treatment
Publisher
American Psychological Association (APA)
Published
2014-10
Volume
5
Issue
4
Pages
428-433
ISSN
  • 1949-2715 (ISSN-L)
  • 1949-2723
DOI
10.1037/per0000065
OpenAlex
W2077647142
Cited by
72
References
23
Citations by year
2025: 5 · 2024: 6 · 2023: 2 · 2022: 4 · 2021: 8 · 2020: 9 · 2019: 4 · 2018: 14 · 2017: 10 · 2016: 3 · 2015: 4 · 2014: 2 · 2013: 1
FWCI
7.47
Type
journal article
Language
en
Open access
closed
Locations
  • Personality Disorders Theory Research and Treatment (publishedVersion)
  • PubMed (publishedVersion)
  • Rutgers University Community Repository (Rutgers University) (submittedVersion)
Funders
  • National Institute of Mental Health (MH012530)
  • International Psychoanalytic Association
  • Austrian National Bank (10636)
  • German Psychoanalytic Society
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
  • Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
Keywords
attachment representations, mentalization, narcissistic personality disorder, borderline personality disorder, comorbidities, female patients, Adult Attachment Interview, dismissing attachment, preoccupied attachment
MeSH terms
Adolescent, Adult, Borderline Personality Disorder, Female, Humans, Interview, Psychological, Middle Aged, Object Attachment, Personality Disorders, Comorbidity, Young Adult, Theory of Mind

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