Living with pathological narcissism: core conflictual relational themes within intimate relationships

Background Pathological narcissism is a severe mental health condition that includes disturbances in interpersonal functioning. Interpersonal difficulties by those affected include aggressive, domineering, cold and coercive behaviours which often result in strong negative reactions from others. We sought to examine the moment-to-moment patterns that emerge within close relationships between intimate partners and family members. Methods Participants (N = 15) were romantic partners (73.3%) and family members (26.6%) in a close and long-term relationship (+ 10 years) with an individual with pathological narcissism. Participants told verbatim relationship narratives involving five narrative interactions with their relative with pathological narcissism and five narrative interactions with others. Transcripts were coded using the using Core Conflictual Relationship Theme method. Participants also completed three versions of the Relationship Questionnaire, reporting on 1. their relationship style ‘in general’, 2. their relationship style ‘with their relative’ and 3. the relationship style of their relative. Results A total of 133 relationship episodes were analysed, comprising 783 components (wishes, responses of others and responses of self). While the identified wishes (e.g., for love, for support) were consistent between relative and non-relative narratives, there was significantly higher disharmony and lower harmony in narratives involving relatives with pathological narcissism. Described disharmony in these relationships involved the relative’s rejecting, subjugating and attacking behaviours, and participants rejecting and withdrawing behaviours. There was a prominent deactivation of participants attachment system when interacting with their relative with pathological narcissism, endorsing predominately dismissing relationship styles. Individuals with pathological narcissism were similarly rated as predominately dismissing. Conclusions Together, these results reflect the cycles of interpersonal dysfunction for individuals with pathological narcissism and their partners and family members. Treatment implications point to the risk of therapists withdrawing and dismissing a patient with high pathological narcissism in the countertransference. Strategies to monitor and manage these core relational themes in treatment remain a challenge.

The End of Monogamy? An Exploration of Non-monogamous Relationship Dynamics

Although monogamy is the dominant relationship style in the Western world, there are alternative options for non-monogamous relationship dynamics. This paper works to explore how the roots of how monogamy became the dominant structure, the hidden drawbacks of monogamy, how those who assert monogamy to be compulsory hold a stigma against those who partake in other dynamics, and how this stigma can work to oppress. It also explores what those dynamics are, who participates in them, and a myriad of benefits that non-monogamous relationships can have. Overall coming to the conclusion that everyone should be able to make an informed decision, free of societal judgment, to partake in whatever dynamic they may choose.

Validation of the Relationships Questionnaire (RQ) against the Experience of Close Relationship-Revised Questionnaire in a Clinical Psychiatric Sample

Background: The Relationship Questionnaire (RQ) is a commonly used self-reporting questionnaire used to measure adult attachment styles. The RQ has two parts. RQ1, a single item where individuals have to indicate their preferred relationship style, and RQ2, where individuals can rate their relationship style in more detail using four different scales. Agreement is expected between the highest levels selected and the style chosen in RQ1. An advantage of the RQ is its brevity, whereas a disadvantage is that it constitutes a single item. A validation of RQ has not been clearly demonstrated, even though it has convergent validity in relation to other measurements in this area. Methods: 168 patients completed the RQ, the short version of the Experience in Close Relationships (Revised) questionnaire (ECR-R), and scales of depression and interpersonal problems. Regression analysis was conducted to examine the congruity in regard to attachment theory. Results: ratings from 15.5% of the patients showed disagreement between RQ1 and RQ2. Each type of attachment measured by the RQ was predicted by the ECR-R scores, as hypothesized. In the predictive analysis of depression and interpersonal problems, both RQ dimensions and ECR-R scores were coherent. Conclusions: RQ is a valid self-reported measurement that can be applied clinically on the condition that the rater identifies an agreement between RQ1 and RQ2.

Searching in the dark: Shining a light on some predictors of non-response to psychotherapy for borderline personality disorder

Background Borderline Personality Disorder (BPD) is a prevalent and serious mental health condition. People can experience recovery or remission after receiving psychotherapy for BPD; however, it is estimated that about 45% of people in well conducted treatment trials do not respond adequately to current psychological treatments. Aim To further advance psychotherapies for BPD by identifying the factors that contribute to the problem of non-response. Method 184 consecutive participants with BPD in community treatment were naturalistically followed up over 12 months and measures of personality and social functioning were examined. Logistic regressions were used to determine which baseline factors were associated with the likelihood of being a non-responder after 12 months of psychotherapy. After 12 months, 48.4% of participants were classed as non-responders due to a lack of reduction in BPD symptoms according to the Reliable Change Index (RCI) method. Results At baseline intake, patients who endorsed an adult preoccupied attachment relationship style and increased anger were more likely to be a non-responder regarding BPD symptoms at 12 months. In addition, those with preoccupied attachment patterns in their adult relationships were more likely to be non-responders regarding general psychological distress at follow up. Higher baseline levels of paranoia and endorsement of a dismissive adult relationship style was associated with being a non-responder in regard to global functioning. Conclusions Consistent with previous research, almost half of the sample did not achieve reliable change at 12-month follow up. A relationship style characterised by preoccupied insecurity and high anger seemed to be particularly challenging in being able to benefit from psychotherapy. This style may have affected both relationships outside, but also inside therapy, complicating treatment engagement and alliance with the therapist. Early identification and modification of treatment based on challenges from these relationship styles may be one way to improve psychotherapy outcomes for BPD.

Bindungsmerkmale und Facharztpräferenz bei Medizinstudierenden

Zusammenfassung Hintergrund Basierend auf einer Studie von Ciechanowski et al. (2004) wurde an der Medizinischen Fakultät der Universität Jena eine analoge Erhebung durchgeführt mit dem Ziel einen Zusammenhang zwischen der Facharztpräferenz Medizinstudierender und deren Bindungsmerkmalen zu überprüfen. Methode Eine Stichprobe von 411 Studierenden aus verschiedenen Abschnitten des Studiums der Humanmedizin (73,2% der Studierenden waren Frauen, das mittlere Alter lag bei 22,7 Jahren) wurde nach dem aktuellen Facharzt-Weiterbildungswunsch gefragt und gebeten, sich in 3 verschiedenen Instrumenten der Erwachsenenbindungsforschung selbst zu beschreiben. Dies waren der Relationship Style Questionnaire (RSQ), der Bielefelder Fragebogen zur Partnerschaftserwartung (BFPE) und die Beziehungsspezifischen Bindungsskalen für Erwachsene (BBE) in der Version für die Bindung an die Mutter und den Partner/die Partnerin. Beim Vergleich der Gruppen wurde zunächst die von Ciechanowski et al. [27] vorgeschlagene Differenzierung der Weiterbildung in eine primärärztliche und eine nicht-primärärztliche zugrunde gelegt. Darüber hinaus wurde eine Kategorisierung aus einer Studie von Buddeberg-Fischer et al. [29] mit insgesamt 7 Subgruppen verwendet (Allgemeinmedizin, Innere Medizin, Chirurgie, Anästhesiologie und Notfallmedizin, Pädiatrie, Nervenheilkunde und Gynäkologie/Geburtshilfe). Ergebnisse Beim Gruppenvergleich der beiden Gruppen nach der Kategorisierung von Ciechanowski zeigen sich Unterschiede, die allerdings die aus der ursprünglichen Studie nicht replizieren: Die Studierenden der ersten (primärärztlichen) Gruppe waren insgesamt (im RSQ) unsicherer gebunden und zeigten höhere Werte in Skalen, die eher auf Abhängigkeit und anklammernde Bindung hindeuten (Angst vor Trennung, Abhängigkeit im Hinblick auf Mutter und Partner(in)). Ähnlich wie bei Ciechanowski et al. [27] waren in der zweiten Gruppe (nicht-primärärztliche Tätigkeit) mehr Personen in der Kategorie „vermeidend“ (selbst-genügsam). Um das Bild zu differenzieren wurden die Kategorien nach Buddeberg-Fischer et al. [29] verglichen. Dieser Vergleich machte deutlich, dass künftige Pädiater und Pädiaterinnen vergleichsweise bindungsunsicherer und ambivalenter klassifiziert wurden, die Anästhesiologen/Notfallmediziner dagegen etwas häufiger als vermeidend und abweisend. Auf der Ebene der Skalenvergleiche bestätigte sich dieses Bild. Da sich sowohl im Hinblick auf die Facharztpräferenz also auch im Hinblick auf Bindungsmerkmale (erfasst mit dem BFPE) Geschlechtsunterschiede zeigten, wurde die Variable Geschlecht als Kovariate in Gruppenvergleichen verwendet. Schlußfolgerungen Im Gegensatz zu der Studie von Ciechanowski u. a. waren speziell künftige Kinderärzte durchgängig, d. h. in allen Bindungsdiagnostika, durch eine Neigung zur Abhängigkeit und zum Anklammern in Beziehungen gekennzeichnet, während teilweise in Analogie zu der US-amerikanischen Studie Bindungsvermeidung und Selbstgenügsamkeit speziell bei künftigen Anästhesisten und Notfallmedizinern häufiger waren. In künftigen Studien zur Motivation für bestimmte ärztliche Tätigkeitsfelder wäre die Hinzuziehung anderer psychologischer Merkmale und insbesondere biografischer Aspekte sinnvoll.

Hubungan Kelekatan Terhadap Kepuasan Hubungan Romantis Pada Mahasiswa Politeknik Kesehatan dr. Soepraoen Malang yang di Mediasi oleh Kepercayaan

Penelitian ini bertujuan untuk melihat hubungan gaya kelekatan terhadap kepuasan hubungan romantis pada mahasiswa yang dimediasi oleh kepercayaan. Populasi dalam penelitian ini adalah mahasiswa D3 Kebidanan semester 1 angkatan 2017 Poltekkes RS dr. Soepraoen Malang yang berjumlah 39 orang. Data dikumpulkan melalui angket menggunakan skala Relationship Style Questionnaire untuk mengukur gaya kelekatan, skala kepercayaan dan Relationship Assesment Scale untuk mengukur kepuasan hubungan romantis. Penelitian ini adalah jenis penelitian kuantitatif . Penelitian ini menggunakan teknik sampling jenuh dan pengumpulan data menggunakan skala likert, dengan program SPSS versi 20,2. Hasil analisis penelitian menunjukkan bahwa terdapat hubungan kelekatan, kepercayaan dengan kepuasan hubungan romantis dengan nilai p (0,003 < 0,05).