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The Almost Untreatable Narcissistic Patient
Abstract
Clinical experience in the Personality Disorders Institute at Weill Cornell Medical College suggests that patients with borderline personality organization and a narcissistic personality disorder have a more serious prognosis than all other personality disorders functioning at the borderline level, and that those who in addition present significant antisocial behavior have an even worse prognosis (Clarkin, Yeomans, and Kernberg 1999; Stone 1990). This negative trend culminates in a group of practically untreatable patients with antisocial personality disorder, who represent the most severe cases of pathological narcissism. There are also patients with severe narcissistic personality disorder, functioning at an overt borderline level with significant antisocial features, but not presenting an antisocial personality disorder proper, who at times respond to treatment, while others do not. These patients are explored here, with a focus on particular psychotherapeutic techniques that have proven helpful, as well as on the limits of these technical approaches.
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“Experts have different opinions about the best treatment approach, but patients affected by NPD are often considered resistant or even untreatable (62, 63).”
From The dark side of empathy in narcissistic personality disorder (2023) · cites this paper as [62]
In the citing paper
“Patients affected by narcissistic personality disorder are often considered among the most difficult to be treated (62, 63).”
From The dark side of empathy in narcissistic personality disorder (2023) · cites this paper as [62]
In the citing paper
“Regarding the ‘vengeful’ node, Kernberg [16], Kernberg [59] describes that as a result of a pain-rage-hatred cycle, justification of revenge against the frustrating object is an almost unavoidable consequence.”
From Living with pathological narcissism: a qualitative study (2020) · cites this paper as [59]
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Metadata
- Authors
- Kernberg, O. F.
- Affiliations
- NewYork–Presbyterian Hospital (US)
- Corresponding author
- Kernberg, Otto F.
- Venue
- Journal of the American Psychoanalytic Association
- Publisher
- SAGE Publications
- Published
- 2007-06
- Volume
- 55
- Issue
- 2
- Pages
- 503-539
- ISSN
- 0003-0651 (ISSN-L)
- 1941-2460
- OpenAlex
- W2090114408
- Cited by
- 143
- References
- 19
- Citations by year
- 2026: 9 · 2025: 8 · 2024: 9 · 2023: 8 · 2022: 14 · 2021: 9 · 2020: 8 · 2019: 2 · 2018: 6 · 2017: 7 · 2016: 7 · 2015: 7 · 2014: 8 · 2013: 9 · 2012: 11
- FWCI
- 3.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Psychoanalytic Association (publishedVersion)
- PubMed (publishedVersion)
- 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
- narcissistic personality disorder, borderline personality organization, antisocial personality disorder, pathological narcissism, treatment resistance, psychotherapeutic techniques, prognosis, antisocial behavior, borderline personality disorder
- MeSH terms
- Adult, Antisocial Personality Disorder, Borderline Personality Disorder, Countertransference, Defense Mechanisms, Female, Humans, Male, Middle Aged, Personality Disorders, Physician-Patient Relations, Prognosis, Psychoanalytic Theory, Psychoanalytic Therapy, Sick Role, Suicide, Attempted, Transference, Psychology, Unconscious, Psychology, Treatment Failure
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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