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Adams, P.L. (1973). Obsessive Children. New York: Bruner/Mazel, Inc.

Alvarez, A. (2010). “Levels of analytic work and levels of pathology: The work of calibration.” The International Journal of Psychoanalysis, 91: 859-878.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Astor, J. (2004). “Response to Dr. Britton’s paper.” Journal of Analytical Psychology, 49: 491-493.

Astor, J. (2007). “Fordham, feeling, and countertransference: Reflections on defences of the self.” Journal of Analytical Psychology, 52: 185-205.

Balint, E. (1991). “One analyst’s technique. In: Before I was I: Psychoanalysis and the Imagination” (pp. 120-129). London: Free Association, 1993.

Balint, M. (1968). The Basic Fault. London: Tavistock.

Barnett, J, (1969). “On aggression in the obsessional neuroses.” Contemporary Psychoanalysis, 6, 48-57.

Becker, D. F., W. S. Edell, C. M. Grilo, and T. H. McGlashan. 2000. “Comorbidity of borderline personality disorder with other personality disorders in hospitalized adolescents and adults.” American Journal of Psychiatry 157.12: 2011-2016.

Beebe, B., & Lachmann, F. (2002). Infant Research and Adult Treatment: Co-constructing Interactions. Hillsdale, NJ: Analytic Press.

Beebe, B., & Lachmann, F. (2013). The Origins of Attachment: Infant Research and Adult Treatment. Abingdon: Taylor & Francis.

Benjamin, J. (1988). The Bonds of Love: Psychoanalysis, Feminism, and the Problem of Domination. New York: Pantheon.

Benjamin, J. (1998). Shadow of the Other: Intersubjectivity and Gender in Psychoanalysis. New York & London: Routledge.

Benjamin, J. (2004). “Beyond doer and done to: An intersubjective view of thirdness.” Psychoanalytic Quarterly, 73: 5-46.

Bentall, R. P. (2004). Madness explained: Psychosis and human nature. Penguin UK.

Bion, W. R. (1959). “Attacks on linking.” International Journal of Psychoanalysis, 40: 308-315. Reprinted In: Second Thoughts (pp. 93-109). New York: Jason Aronson, 1967.

Bion, W. R. (1962a). Learning from Experience. London: Heinemann.

Bion, W. R. (1962b). “The psycho-analytic study of thinking.” International Journal of Psychoanalysis, 43: 306-310.

Bion, W. R. (1965). Transformations: Change from Learning to Growth. London: Tavistock.

Bion, W. R. (1970). Attention and Interpretation. Oxford: Routledge.

Bion, W. R. (1992). Cogitations. London: Karnac.

Birtles, E.F. and Scharff, D.E. (1994). From Instinct to Self, Selected Papers of W.R.D. Fairbairn, Vol. ll, Northvale, NJ. Jason Aronson Inc.

Bohleber, W. (2007). “Remembrance, trauma and collective memory.” International Journal of Psychoanalysis, 88: 329-352.

Bohleber, W. (2010). Destructiveness, Intersubjectivity and Trauma: The Identity Crisis of Modern Psychoanalysis. London: Karnac.

Bollas, C. (1987). The Shadow of the Object: Psychoanalysis of the Unthought Known. New York: Columbia University Press.

Bollas, C. (2000). Hysteria. Abingdon: Taylor & Francis.

Boon, S., Steele, K., & van der Hart, O. (2011). “Coping with Trauma-Related Dissociation: Skills Training for Patients and Therapists.” New York: Norton. Boston Change Process Study Group (BCPSG) [Stern, D. N., Sander, L. W., Nahum, J. P., Harrison, A. M., Lyons-Ruth, K., Morgan, A].

Boston Change Process Study Group (BCPSG) (2007). “The foundational level of psychodynamic meaning: implicit process in relation to conflict, defense, and the dynamic unconscious.” International Journal of Psychoanalysis, 88: 843-860. Reprinted in: Boston Change Process Study Group. Change in Psychotherapy: A Unifying Paradigm. New York: Norton, 2010.

Bouchard, M., Normandin, L., & Séguin, M. (1995). “Countertransference as instrument and obstacle: a comprehensive and descriptive framework.” Psychoanalytic Quarterly, 64: 717-745.

Bowlby, J. (1969). Attachment and Loss, Volume 1: Attachment. Harmondsworth: Penguin Books.

Bremner, J. D. (1999). “Acute and chronic responses to psychological trauma: Where do we go from here?” American Journal of Psychiatry, 156: 349-351.

Breuer, J., & Freud, S. (1893). On the psychical mechanism of hysterical phenomena. Studies on Hysteria, S. E., 2: 1-17. London: Hogarth.

Britton, R. (1989). “The missing link: parental sexuality in the Oedipus complex.” In: R. Britton, M. Feldman, & E. O’Shaughnessy (Eds.), The Oedipus Complex Today: Clinical Implications. London: Karnac.

Britton, R. (1998). Subjectivity, objectivity and triangular space. In: Belief and Imagination: Explorations in Psychoanalysis (pp. 41-58). Hove: Routledge.

Britton, R. (2003). Sex, Death, and the Superego: Experiences in Psychoanalysis. London: Karnac.

Britton, R. (2004). Narcissistic disorders in clinical practice. Journal of Analytical Psychology, 49: 477-490.

Bromberg, P. (2011). The Shadow of the Tsunami: and the Growth of the Relational Mind. New York: Routledge.

Broucek, F. J. (1991). Shame and the Self. Guilford Press.

Bruch, H. (1978). The Golden Cage: The Enigma of Anorexia Nervosa. Cambridge, Mass. Harvard University Press.

Buckley, P. Ed., (1986). Essential Papers on Object Relations. New York; New York Universities Press.

Bureau, J.-F., Martin, J., & Lyons-Ruth, K. (2010). Attachment dysregulation as hidden trauma in infancy: early stress, maternal buffering and psychiatric morbidity in young adulthood. In: R. Lanius, E. Vermetten & C. Pain (Eds.), The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic (pp. 48-56). Cambridge: Cambridge University Press.

Cain, N. M., A. L. Pincus, and E. B. Ansell. (2008). “Narcissism at the crossroads: Phenotypic description of pathological narcissism across clinical theory, social/personality psychology, and psychiatric diagnosis.” Clinical Psychology Review 28:638-656.

Campbell, W. K., and J. D. Foster. (2007). The narcissistic self: Background, an extended agency model, and ongoing controversies. In Frontiers in social psychology: The self. Edited by C. Sedikides and S. Spencer, 115-138. Philadelphia: Psychology Press.

Campbell, W. K., and J. D. Miller, eds. (2011). The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings, and treatments. Hoboken, NJ: Wiley.

Caper, R. (1999). A Mind of One’s Own: A Psychoanalytic View of Self and Object. Abingdon: Taylor & Francis.

Carter, L. (2011). “A Jungian contribution to a dynamic systems understanding of disorganized attachment.” Journal of Analytical Psychology, 56: 334-340.

Casement, P. J. (1985). On Learning from the Patient. Hove: Routledge.

Casement, P. J. (2001). “Commentaries.” Journal of the American Psychoanalytic Association, 49: 381-386.

Cassidy, J. (2008). The nature of the child’s ties. In: J. Cassidy & P. R. Shaver (Eds.), Handbook of Attachment: Theory, Research, and Clinical Applications (pp. 3-22). New York: Guilford Press.

Cassidy, J., & Mohr, J. J. (2001). “Unsolvable fear, trauma and psychopathology: theory, research and clinical considerations related to disorganized attachment across the life cycle.” Clinical Psychology: Science and Practice, 8: 275-298.

Celani, D.P. (1976). An interpersonal approach to hysteria. American Journal of Psychiatry. (12), 1414-1418.

Celani D.P. (1993). The Treatment of The Borderline Patient: Applying Fairbairn’s Object Relations Theory in the Clinical Setting. International Universities Press, Madison, CT.

Celani, D.P. (1994). The Illusion of Love: Why The Battered Woman Returns To Her Abuser. Columbia University Press, New York.

Celani, D.P. (1996). The dynamics of the battering couple. The Health Care Review. 9, (6).

Celani, D.P. (1997). Perspectives on psychopathology. Review of Part IV: Psychopathology, in The Handbook of Interpersonal Psychoanalysis. Marylou, John Fiscalini, Carola Mann, and Donell Stern, Eds. Contemporary Psychoanalysis, 33, 2, 323-333.

Celani, D.P. (1998). Structural sources of resistance in battered women, a Fairbairnian analysis. In Fairbairn Then and Now, Skolnick, N. and Scharff, D. Eds. The Analytic Press, Hillsdale, N.J., 235-254.

Celani, D.P. (1999). Applying Fairbairn’s object relations theory to the dynamics of the battered woman. American Journal of Psychotherapy, 53, (1), 60-72.

Celani, D.P. (2001). Working with Fairbairn’s ego structures. Contemporary Psychoanalysis, 37 (3), 391-416.

Celani, D.P. (2005). Leaving Home: The Art of Separating From Your Difficult Family. Columbia University Press, New York

Celani, D.P. (2007). A structural analysis of the obsessional character: A Fairbairnian perspective. American Journal of Psychoanalysis, 67 (2), 119-140.

Celani, D.P. (2010). Fairbairn’s Object Relations Theory in the Clinical Setting. Columbia University Press, New York.

Celani, D.P. (2014). A Fairbairnian structural analysis of the narcissistic personality disorder. The Psychoanalytic Review, 101 (3), 385-409.

Celani, D.P. (2014). Revising Fairbairn’s structural theory. In Fairbairn And The Object Relations Tradition, G.Clarke and D.Scharff eds, Karnac Books, London, pp. 397-409.

Celani, D.P. Fairbairn’s theory of change. (2016). The Psychoanalytic Review, 103 (3), 341-370.

Charcot, J. M. (1877). Lectures on the diseases of the nervous system: Delivered at La Salpêtrière (Vol. 1). New Sydenham Society.

Clarke, G.S. and Scharff, D.E. Eds. (2014). Fairbairn and the Object Relations Tradition, London, Karnac Books.

Cocks, G. (2002). Heinz Kohut: The making of a psychoanalyst. Journal of the American Psychoanalytic Association, 50: 1385-1390.

Coltart, N. (1986). Slouching towards Bethlehem … or thinking the unthinkable in psychoanalysis. In: G. Kohon (Ed.), The British School of Psychoanalysis: The Independent Tradition (pp. 185-199). New Haven, CT: Yale University Press. Also in: Coltart, N., Slouching Towards Bethlehem … and Further Psychoanalytic Explorations (pp. 1-14). London: Free Association, 1993.

Davies, J. M. (1997). Dissociation, therapeutic enactment, and transference-countertransference processes: A discussion of papers on childhood sexual abuse by S. Grand and J. Sarnat. Gender and Psychoanalysis, 2: 241-257.

Davies, J. M. (2004). Whose bad objects are we anyway? Psychoanalytic Dialogues, 14: 711-732.

Davies, J. M., & Frawley, M. G. (1992a). Dissociative processes and transference-countertransference paradigms in the psychoanalytically oriented treatment of adult survivors of childhood sexual abuse. Psychoanalytic Dialogues, 2: 5-36.

Dickinson, K. A., and A. L. Pincus. (2003). Interpersonal analysis of grandiose and vulnerable narcissism. Journal of Personality Disorders 17:188-207.

Ellis, H. (1898). Auto-eroticism: A psychological study. Alienist and Neurologist 19:260-299.

Fairbairn, W.R.D. (1952). Psychoanalytic Studies of the Personality, London: Routledge & Kegan Paul.

Ferenczi, S. (1932a). Confusion of tongues between adults and the child. In: M. Balint (Ed.), E. Mosbacher and others (Trans), Final Contributions to the Problems and Methods of Psycho-analysis (pp. 156-167). London: Hogarth, 1955.

Ferenczi, S. (1932b). On shock. In: M. Balint (Ed.), E. Mosbacher and others (Trans), Final Contributions to the Problems and Methods of Psycho-analysis (pp. 253-254). London: Hogarth, 1955.

Ferenczi, S. (1985). The Clinical Diary of Sándor Ferenczi, J. Dupont (Ed.), M. Balint & N. Zarday Jackson (Trans). Cambridge, MA: Harvard University Press, 1988.

Fonagy, P. (1991). Thinking about thinking: some clinical and theoretical considerations in the treatment of a borderline patient. International Journal of Psychoanalysis, 72: 639-656.

Fonagy, P. (2001). Attachment Theory and Psychoanalysis. New York: Other Press.

Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2002). Affect Regulation, Mentalization and the Development of the Self. London: Karnac.

Fonagy, P., Gergely, G., & Target, M. (2008). Psychoanalytic constructs and attachment theory and research. In: J. Cassidy & P. R. Shaver (Eds.), Handbook of Attachment: Theory, Research, and Clinical Applications (pp. 783-810). New York: Guilford, 2010.

Fonagy, P., Steele, H., Moran, G., Steele, M., & Higgit, A. (1991). “The capacity for understanding mental states: the reflective self in parent and child and its significance for security of attachment.” Infant Mental Health Journal, 13: 200-217.

Fonagy, P., Steele, H., & Steele, M. (1991). “Maternal representations of attachment during pregnancy predict the organization of infant-mother attachment at one year of age.” Child Development, 62: 891-905.

Fonagy, P., Target, M., Gergely, G., Allen, J. G., & Bateman, A. W. (2003). “The developmental roots of borderline personality disorder in early attachment relationships.” Psychoanalytic Inquiry, 23: 412-459.

Fordham, M. (1969). Children as Individuals. London: Hodder & Stoughton.

Fordham, M. (1974). Defences of the self. Journal of Analytical Psychology, 19: 192-199. Reprinted in: Fordham, M., Analyst-Patient Interaction: Collected Papers on Technique, S. Shamdasani (Ed.) (pp. 138-145). London: Routledge, 1996.

Fordham, M. (1993). “On not knowing beforehand.” Journal of Analytical Psychology, 38: 127-136.

Foulkes, S. H. (1964). Therapeutic Group Analysis. London: Allen & Unwin.

Fosatti, A., T. P. Beauchaine, F. Grazioli, L. Carretta, F. Cortinovis, and C. Maffei. (2005). A latent structure analysis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, narcissistic personality disorder criteria. Comprehensive Psychiatry 46:1321-1332.

Foster, J. D., and J. C. Brennan. (2011). Narcissism, the agency model, and approach-avoidance motivation. In The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings, and treatments. Edited by W. K. Campbell and J. D. Miller, 89-100. Hoboken, NJ: Wiley.

Foster, J. D., and W. K. Campbell. (2007). Are there such things as “narcissists” in social psychology? A taxometric analysis of the Narcissistic Personality Inventory. Personality and Individual Differences 43:1321-1332.

Foucault, M. (1961). Madness and civilization. Routledge.

Freud, S. (1894a). “The neuro-psychoses of defence.” S. E., 3: 41-61. London: Hogarth. Freud, S. (1895c [1894]). “Obsessions and phobias.” S. E., 3: 69-82. London: Hogarth.

Freud, S. (1897b). “Abstracts of the Scientific Writings of Dr. Sigmund Freud (1877-1897).” S. E., 3: 223-257. London: Hogarth.

Freud, S. (1900a). “The Interpretation of Dreams.” S. E., 4. London: Hogarth.

Freud, S. (1914c). “On narcissism: an introduction.” S. E., 14: 67-102. London: Hogarth.

Freud, S. (1914g). “Remembering, repeating and working-through (further recommendations on the technique of psycho-analysis II).” S. E., 12: 145-156. London: Hogarth.

Freud, S. (1916-17). “Introductory Lectures on Psycho-Analysis.” S. E., 15: 1-240.

Freud, S. (1923b). “The Ego and the Id.” S. E., 14: 1-66. London: Hogarth.

Freud, S. (1924c). “The economic problem of masochism.” S. E., 14: 155-170. London: Hogarth.

Freud, S. (1926d). “Inhibitions, Symptoms and Anxiety.” S. E., 20: 75-176. London: Hogarth.

Freud, S. (1937c). “Analysis terminable and interminable.” S. E., 23: 209-254. London: Hogarth. https://icpla.edu/wp-content/uploads/2012/10/Freud-S.-Analysis-Terminable-and-Interminable.pdf

Freud, S. (1957a). Three essays on sexuality. In The standard edition of the complete psychological works of Sigmund Freud. Vol. 7. Edited and translated by J. Strachey, 125-245. London: Hogarth.

Freud, S. (1950). Libidinal types. In The standard edition of the complete psychological works of Sigmund Freud. Vol. 21. Edited and translated by J. Strachey, 217-220. London: Hogarth.

Freud, S., & Jung, C. G. (1974). The Freud/Jung Letters, W. McGuire (Ed.). Princeton, NJ: Princeton University Press.

Gabbard, G. O. (1992). Commentary on “Dissociative processes and transference-countertransference paradigms” by Jody Messler Davies and Mary Gale Frawley. Psychoanalytic Dialogues, 2: 37-47.

Gabbard, G. O. (1997). “Challenges in the analysis of adult patients with histories of childhood sexual abuse.” Canadian Journal of Psychoanalysis, 5: 1-25.

Gabbard, G. O., & Lester, E. (1995). “Boundaries and Boundary Violations in Psychoanalysis.” Arlington, VA: American Psychiatric Publishing.

Garland, C. (1998a). Understanding Trauma: A Psychoanalytical Approach. London: Karnac.

Garland, C. (1998b). Thinking about trauma. In: C. Garland (Ed), Understanding Trauma: A Psychoanalytical Approach (pp. 9-32). London: Karnac.

Greenberg, J. R., & Mitchell, S. (1983). Object Relations in Psychoanalytic Theory. Cambridge, MA: Harvard University Press.

Grotstein, J.S. and Rinsley, D.B. Eds. (1984). Fairbairn and the Origins of Object Relations. New York, NY, The Guilford Press.

Gunderson, J. G., & Singer, M. T. (1975). “Defining borderline patients: an overview.” American Journal of Psychiatry, 132: 1-10. Reprinted in: M. H. Stone (Ed.), Essential Papers on Borderline Disorders (pp. 453-474). New York: New York University Press, 1986.

Gunderson, J. G., Ronningstam, E., & Smith, L. E. (1991). Narcissistic personality disorder: a review of data on DSM-III-R descriptions. Journal of Personality Disorders, 5(2), 167-177.

Guntrip, H. (1952/1980). Schizoid Phenomena, Object-relations and the Self. London: Hogarth.

Herman, J. L., Perry, J. C., & van der Kolk, B. A. (1989). Childhood trauma in borderline personality disorder. American Journal of Psychiatry, 146: 490-495.

Lewis Herman, J. (1992). Trauma and recovery. NY: Basic Books, 34-35.

Hinshelwood, R.D. (1988). A Dictionary of Kleinian Thought. Free Association Books.

Hollender, M. (1971). “Hysterical personality.” Comments on Contemporary Psychology, 1:17-24.

Howell, E.F. (2005). The Dissociative Mind, Hillsdale, NJ, The Analytic Press.

Kainer, R.G. (1979). The critical voice in the treatment of the obsessional. Contemporary Psychoanalysis, 15, 276-287.

Kernberg, O. F. (1986). “Factors in the psychoanalytic treatment of narcissistic personalities.” In Essential papers on narcissism. Edited by A. P. Morrison, 213-244. New York and London: New York Univ. Press.

Kernberg, O. F. (1975). Borderline conditions and pathological narcissism. Northvale, NJ: Aronson.

Kernberg, O. F. (2012). “Back From the Edge”: Borderline Personality Disorder Resource Center at NewYork-Presbyterian. https://www.youtube.com/watch?v=967Ckat7f98 [last accessed 24.6.2018]

Klonsky, E. D., Jane, J. S., Turkheimer, E., & Oltmanns, T. F. (2002). “Gender role and personality disorders.” Journal of Personality Disorders, 16(5), 464-476.

Jacoby, M. (1996). Shame and the Origins of Self-esteem: A Jungian Approach. Abingdon: Taylor & Francis.

Janet, P. (1893a). L’état Mental des Hystériques: Les Stigmates Mentaux. Paris: Rueff & Cie.

Janet, P. (1893b). Contribution à L’étude des Accidents Mentaux chez les Hystériques. Paris: Rueff & Cie.

Janet, P. (1893c). “L’Amnésie continue.” Revue Generale des Sciences, 4: 167-179.

Janet, P. (1894). Létat Mental des Hystériques: Les Accidents Mentaux. Paris: Rueff & Cie.

Janet, P. (1904). “L’Amnésie et la dissociation des souvenirs par l’émotion.” Journal de Psychologie, 1: 417-453.

Jung, C. (1911-12). Symbols of Transformation. C.W. 5. London: Routledge & Kegan Paul.

Jung, C. G. (1917/1926/1943). On the psychology of the unconscious. In: Two Essays on Analytical Psychology, C.W. 7. London: Routledge & Kegan Paul.

Jung, C. G. (1921/1928). The therapeutic value of abreaction. In: The Practice of Psychotherapy, C.W. 16. London: Routledge & Kegan Paul.

Jung, C. G. (1958). Schizophrenia. In: The Psychogenesis of Mental Disease, C.W. 3: 256-271. London: Routledge & Kegan Paul.

Kernberg, O. (1975). Borderline Conditions and Pathological Narcissism. New York: Aronson.

Klein, M. (1946). Notes on some schizoid mechanisms. In: Envy and Gratitude: and Other Works, 1946-1963 (pp. 1-24). London: Virago.

Knox, J. (2003b). Trauma and defences. Journal of Analytical Psychology, 48: 207-233.

Knox, J. (2007). The fear of love: the denial of self in relationship. Journal of Analytical Psychology, 52: 543-563.

Knox, J. (2008). Response to “Report from borderland”. Journal of Analytical Psychology, 53: 31-36.

Knox, J. (2009). When words do not mean what they say. Self-agency and the coercive use of Language. Journal of Analytical Psychology, 54: 25-41.

Knox, J. (2010). Self-agency in Psychotherapy: Attachment, Autonomy, and Intimacy. New York: Norton.

Kohut, H. (1966). Forms and transformations of narcissism. Journal of the American Psychoanalytic Association 14:243-272.

Kohut, H. (1971). The Analysis of the Self. New York: International Univ. Press.

Kohut, H. (1977). The restoration of the self. New York: International Univ. Press.

Koos, O., & Gergely, G. (2001). A contingency-based approach to the aetiology of “disorganized” attachment: the “flickering switch” hypothesis. Bulletin of the Menninger Clinic, 65: 397-410.

Kreisman, J. J. & Straus, H. (1989/2011). I Hate You-Don’t Leave Me: Understanding the Borderline Personality. New York: Penguin Putnam.

Krystal, H. (1978). Trauma and affects. Psychoanalytic Study of the Child, 33: 81-116.

Krystal, H. (1988). Integration and Self-Healing: Affect, Trauma, and Alexithymia. Hillsdale, NJ: Analytic Press.

Lasch, C. (1979). The culture of narcissism: American life in an age of diminishing expectations. New York: Norton.

Levy, K. N., W. D. Ellison, and J. S. Reynoso. (2011). A historical review of narcissism and narcissistic personality. In The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings, and treatments. Edited by W. K. Campbell and J. D. Miller, 3-13. Hoboken, NJ: Wiley.

Lewis, H. B. (1990). Shame, repression, field dependence, and psychopathology. In: J. L. Singer (Ed.), Repression and Dissociation: Implications for Personality Theory, Psychopathology and Health (pp. 233-257). Chicago, IL: University of Chicago Press.

Lindy, J. D. (1996). Psychoanalytic psychotherapy of posttraumatic stress disorder: the nature of the therapeutic relationship. In: B. van der Kolk, A., McFarlane, & L. Weisaeth (Eds.), Traumatic Stress: The effects of overwhelming experience on mind, body and society (pp. 525-536). New York: Guildford Press.

Liotti, G. (1992). “Disorganized/disoriented attachment in the etiology of the dissociative disorders.” Dissociation, 5: 196-204.

Liotti, G. (1995). “Disorganized/disoriented attachment in the psychotherapy of the dissociative disorders.” In: S. Goldberg, R. Muir & J. Kerr (Eds.), Attachment Theory: Social, Developmental and Clinical Perspectives (pp. 343-363). Hillsdale, NJ: Analytic Press.

Liotti, G. (1999). “Understanding the dissociative processes: the contribution of attachment theory.” Psychoanalytic Inquiry, 19: 757-783.

Liotti, G. (2004a). “Trauma, dissociation, and disorganized attachment: three strands of a single braid.” Psychotherapy: Theory, Research, Practice, Training; 41: 472-486.

Liotti, G. (2004b). The inner schema of borderline states and its correction during psychotherapy: a cognitive-evolutionary approach. In: P. Gilbert (Ed.), Evolutionary Theory and Cognitive Psychotherapy (pp. 137-160). New York: Springer.

Liotti, G. (2007). Disorganized attachment and the therapeutic relationship with people in shattered states. In: J. Yellin & K. White (Eds.), Shattered States: Disorganised Attachment and Its Repair (pp. 127-156). London: Karnac, 2012.

Loewenstein, R. J., & Putnam, F. W. (2004). The dissociative disorders. In: B. J. Sadock & V. A. Sadock (Eds.), Comprehensive textbook of psychiatry (9th ed.) (pp. 1844-1901). Baltimore, MD: Williams & Wilkins.

Lunbeck, E. (2014). The Americanization of Narcissism. Harvard: Harvard University Press.

Lyons-Ruth, K. (1998). Implicit relational knowing: its role in development and psychoanalytic treatment. Infant Mental Health Journal, 19: 282-289. Reprinted in: Boston Change Process Study Group (BCPSG). Change in Psychotherapy: A Unifying Paradigm (pp. 30-53). New York: Norton, 2010.

Lyons-Ruth, K. (1999). “The two-person unconscious: intersubjective dialogue, enactive relational representation, and the emergence of new forms of relational organization.” Psychoanalytic Inquiry, 19: 576-617.

Lyons-Ruth, K. (2003). “Dissociation and the parent-infant dialogue: a longitudinal perspective from attachment research.” Journal of the American Psychoanalytic Association, 5: 883-911.

Lyons-Ruth, K. (2008). “Contributions of the mother-infant relationship to dissociative, borderline, and conduct symptoms in young adulthood.” Infant Mental Health Journal, 29: 203-218.

Lyons-Ruth, K., Bronfman, E., & Parsons, E. (1999). “Maternal frightened, frightening, or atypical behavior and disorganized infant attachment patterns.” Monographs of the Society for Research in Child Development, 64: 67-96.

Lyons-Ruth, K., Dutra, L., Schuder, M., & Bianchi, I. (2006). “From infant attachment disorganisation to adult dissociation: relational adaptations or traumatic experiences?” Psychiatric Clinics of North America, 29: 63-86.

Lyons-Ruth, K., Yellin, C., Melnick, S., & Atwood, G. (2003). “Childhood experiences of trauma and loss have different relations to maternal unresolved and hostile-helpless states of mind on the AAI.” Attachment and Human Development, 5: 330-352.

Lyons-Ruth, K., Yellin, C., Melnick, S., & Atwood, G. (2005). “Expanding the concept of unresolved mental states: hostile/helpless states of mind on the Adult Attachment Interview are associated with disrupted mother-infant communication and infant disorganization.” Development and Psychopathology, 17: 1-23.

Main, M., Kaplan, N., & Cassidy, J. (1985). Security in infancy, childhood, and adulthood: A move to the level of representation. In: I. Bretherton & E. Waters (Eds.), Growing points of attachment theory and research (Monographs of the Society for Research in Child Development) (pp. 66-104). Chicago, IL: Chicago University Press.

Main, M., & Morgan, H. (1996). Disorganization and disorientation in infant strange situation behaviour: phenotypic resemblance to dissociative states? In: L. Michelson & W. Ray (Eds.), Handbook of Dissociation (pp. 107-137). New York: Plenum Press.

Main, M., & Solomon, J. (1990). Procedures for identifying infants as disorganised/disoriented during the Ainsworth Strange Situation. In: M. T. Greenberg, D. Cicchetti & E. M. Cummings (Eds.), Attachment in the preschool years: Theory, Research, and Intervention (pp. 95-124). Chicago, IL: Chicago University Press.

Mallinger, A.E. (1982). “Demand sensitive obsessionals.” The Journal of The American Academy of Psychoanalysis. 10: (3), 407-426.

McDougall, J. (1989). Theatres of the Body: Psychoanalytic Approach to Psychosomatic Illness. London: Free Association.

McWilliams, N., & Lependorf, S. (1990). Narcissistic pathology of everyday life: The denial of remorse and gratitude. Contemporary Psychoanalysis, 26(3), 430-451.

Meares, R. (1993). Reversals: on certain pathologies of identification. In: E. Goldberg (Ed.), Progress in Self Psychology, Vol. 9 (pp. 231-246). Hillsdale, NJ: Analytic Press.

Meares, R. (2012). A Dissociation Model of Borderline Personality Disorder. New York: Norton.

Meltzer, D. (1990). The Claustrum: An Investigation of Claustrophobic Phenomena. London: Karnac.

Miller, A. (1981). Prisoners of Childhood: The Drama of the Gifted Child and the Search for the True Self. New York: Basic.

Miller, J. D., T. A. Widiger,and W. K. Campbell. (2010). “Narcissistic personality disorder and the DSM-5.” Journal of Abnormal Psychology 119:640-649.

Miller, J. D., and W. K. Campbell. (2010). “The case for using research on trait narcissism as a building block for understanding narcissistic personality disorder.” Personality Disorders: Theory, Research, and Treatment 1.3: 180-191.

Miller, J. D., E. T. Gaughan, L. R. Pryor, C. Kamen, and W. K. Campbell. (2009). “Is research using the Narcissistic Personality Inventory relevant for understanding narcissistic personality disorder?” Journal of Research in Personality 78:1529-1564.

Mitchell, S.A. (1986) The wings of Icarus: Illusion and the problem of narcissism. Contemporary psychoanalysis, 22, (1), 107-131)

Mitchell, S.A. (1988). Relational Concepts in Psychoanalysis. Cambridge, MA. Harvard University Press.

Mitchell, S.A. (1997). Influence and Autonomy In Psychoanalysis. Hillsdale, N.J., The Analytic Press.

Mitchell, S.A. (2000). Relationality-From Attachment to Intersubjectivity . Hillsdale, N.J., The Analytic Press.

Mollon, P. (1993). The Fragile Self: The Structure of Narcissistic Disturbance. Whurr Publishers.

Mollon, P. (1996). Multiple Selves, Multiple Voices: Working with Trauma, Violation, and Dissociation. New York: Wiley.

Mollon, P. (2002). Shame and Jealousy: The Hidden Turmoils. London: Karnac.

Mollon, P. (2015). The Disintegrating Self: Psychotherapy of Adult ADHD, Autistic Spectrum, and Somato-Psychic Disorders. London: Karnac.

Morf, C. C., and F. Rhodewalt. (2001). “Unraveling the paradoxes of narcissism: A dynamic self-regulatory processing model.” Psychological Inquiry 12:177-196.

Morf, C. C., L. Torchetti, and E. Schurch. (2011). Narcissism from the perspective of the dynamic self-regulatory processing model. In The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings, and treatments. Edited by W. K. Campbell and J. D. Miller, 56-70. Hoboken, NJ: Wiley.

Nacke, P. (1899). “Die sexuellen Perversitäten in der Irrenanstalt.” Psychiatriche en Neurologische Bladen 3:122-149.

Neumann, E. (1966). “Narcissism, normal self-formation and the primary relationship to the mother.” Spring, 66: 81-106.

Ogden, T. (1994). Subjects of Analysis. Northvale, NJ: Aronson.

Ogden, T. (1996). “The perverse subject of analysis.” Journal of the American Psychoanalytic Association, 44: 1121-1146.

Ogden, T. (2009). Rediscovering Psychoanalysis: Thinking and Dreaming, Learning and Forgetting. Hove: Routledge.

Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the Body: A Sensorimotor Approach to Psychotherapy. New York: Norton.

Oldham, J. M. (2006). “Borderline personality disorder: an overview.” Psychiatric Times, 21(8).

Orbach, S. (2004). “The body in clinical practice, part one: there’s no such thing as a body.” In: K. White (Ed.), Touch: Attachment and the Body (pp. 17-34). London: Karnac.

Orbach, S. (2009). Bodies. London: Profile Books. Ornstein, A. (1983). Fantasy or reality? The unsettled question in pathogenesis and reconstruction in psychoanalysis. In: A. Goldberg (Ed.), The Future of Psychoanalysis (pp. 381-396). New York: International University Press.

Olive, R. R. (2018). ‘It’s time psychiatrists stopped stereotyping women with personality disorders – we can speak for ourselves’, in The Independent, 7th June 2018.

Panksepp, J. (1998). Affective Neuroscience: The Foundations of Human and Animal Emotions. New York: Oxford University Press.

Pincus, A. L., Ansell, E. B., Pimentel, C. A., Cain, N. M., Wright, A. G., & Levy, K. N. (2009). “Initial construction and validation of the Pathological Narcissism Inventory.” Psychological assessment, 21(3), 365.

Porges, S. (1995). “Orienting in a defensive world: mammalian modifications of our evolutionary heritage.” Psychophysiology, 32: 301-318.

Porges, S. (2004). “Neuroception: a subconscious system for detecting threats and safety. Zero to Three.” Bulletin of the National Centre for Clinical Infant Programs, 24: 19-24.

Porges, S. (2005). “The role of social engagement in attachment and bonding: a phylogenetic perspective.” In: C. S. Carter, L, Ahnert, K. E. Grossman, S. B. Hardy, M. E. Lamb, S. W. Porges & N. Sachser (Eds.), Attachment and Bonding: A New Synthesis (pp. 33-54). Cambridge, MA: The MIT Press.

Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation. New York: Norton.

Porges, W., Doussard-Roosevelt, J. & Maiti, A. K. (1994). “Vagal tone and the physiological regulation of emotion.” Monographs of the Society for Research in Child Development, 59: 167-186.

Potamianou, A. (1997). Hope: A Shield in the Economy of Borderline States. London: Routledge.

Quinodoz, J.-M. (2005). Reading Freud: A Chronological Exploration of Freud’s Writings. Hove: Brunner-Routledge.

Pincus, A. L., and M. R. Lukowitsky. (2010). “Pathological narcissism and narcissistic personality disorder.” Annual Review of Clinical Psychology 6:421-446.

Pincus, A. L., and M. J. Roche. (2011). Narcissistic grandiosity and narcissistic vulnerability. In The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings, and treatments. Edited by W. K. Campbell and J. D. Miller, 31-41. Hoboken, NJ: Wiley.

Rank, O. (1911). “A contribution to narcissism.” Jahrbuch für Psychoanalytische und Psychopathologische Forschungen 3:401-426.

Rathvon, N., and R. W. Holmstrom. (1996). An MMPI-2 portrait of narcissism. Journal of Personality Assessment 66:1-19.

Reich, A. (1960). “Pathologic forms of self-esteem regulation.” Psychoanalytic Studies of the Child, 15:215-232.

Reynolds, E. K., and C. W. Lejuez. (2011). Narcissism in the DSM. In The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings, and treatments. Edited by W. K. Campbell and J. D. Miller, 14-21. Hoboken, NJ: Wiley.

Rhodewalt, F., and B. Peterson. (2009). Narcissism. In Handbook of individual differences in social behavior. Edited by M. Leary and R. Hoyle, 547-560. New York: Guilford.

Richman, A. (2013). The nature of trauma and dissociation. Online module for Confer Conference, “On the nature of trauma and dissociation”. https://www.confer.uk.com/module-trauma.html

Ronningstam, E., & Gunderson, J. (1991). Differentiating borderline personality disorder from narcissistic personality disorder. Journal of Personality Disorders, 5(3), 225-232.

Ronningstam, E. (1996). “Pathological narcissism and narcissistic personality disorder in Axis I disorders.” Harvard Review of Psychiatry 3:326-340.

Ronningstam, E. (2009). “Narcissistic personality disorder: Facing DSM-V.” Psychiatric Annals 39:111-121.

Ronningstam, E. (2011). “Narcissistic personality disorder in DSM-V-in support of retaining a significant diagnosis.” Journal of Personality Disorders 25:248-259.

Ronningstam, E. (2011). Psychoanalytic theories on narcissism and narcissistic personality. In The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings, and treatments. Edited by W. K. Campbell and J. D. Miller, 41-55. Hoboken, NJ: Wiley.

Rosenfeld, H. (1971). A clinical approach to the psychoanalytic theory of the life and death instincts: an investigation into the aggressive aspects of narcissism. International Journal of Psychoanalysis, 52: 169-178.

Rosenfeld, H. (1987). Impasse and Interpretation: Therapeutic and Antitherapeutic Factors in the Psychoanalytic Treatment of Psychotic, Borderline and Neurotic Patients. London: Routledge.

Roth, P. (1994). “Being true to a false object: a view of identification.” Psychoanalytic Inquiry, 14: 393-405.

Rothschild, B. (2000). The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment. New York: Norton.

Lunbeck, E. (2014). The Americanization of narcissism. Harvard University Press.

Russ, E., J. Shedler, R. Bradley, and D. Westen. 2008. “Refining the construct of narcissistic personality disorder: Diagnostic criteria and subtypes.” American Journal of Psychiatry 165:1473-1481.

Schmideberg, M. (1959). The borderline patient. American Handbook of Psychiatry, vol 1, S. Arieti (Ed.). New York: Basic.

Scharff, D.E. and Birtles, E.F. Eds. (1994). From Instinct To Self, Selected Papers of W.R.D. Fairbairn, Vol.1. Northvale, N.J. Jason Aronson.

Scharff, D.E and Skolnick, N.J. Eds.(1998). Fairbairn, Then And Now. Hillsdale, N.J. The Analytic Press.

Schimel, J.L. (1972). “The power theme in the obsessional.” Contemporary Psychoanalysis. 9, 1-28.

Schore, A. (2003). Affect Regulation and the Repair of the Self. New York: Norton.

Seligman, S. (2003). “The developmental perspective in relational psychoanalysis.” Contemporary Psychoanalysis, 39: 477-508.

Sipp, S. (1977) Interpersonal factors in hysteria: Freud’s seduction theory and the case of Dora. Journal of the American Academy of Psychoanalysis, 5: 359-376.

Steiner, J. (1987). “The interplay between pathological organizations and the paranoid-schizoid and depressive positions.” International Journal of Psychoanalysis, 68: 69-80.

Steiner, J. (1989). “The psychoanalytic contribution of Herbert Rosenfeld.” International Journal of Psychoanalysis, 70: 611-616.

Steiner, J. (1990). “The retreat from truth to omnipotence in Sophocles’ Oedipus at Colonus.” International Review of Psychoanalysis, 17: 227-237.

Steiner, J. (1993). Psychic Retreats: Pathological Organisations in Psychotic, Neurotic and Borderline Patients. London: Routledge.

Steiner, J. (1996). “The aim of psychoanalysis in theory and in practice.” International Journal of Psychoanalysis, 77: 1073-1083.

Stern, A. (1938). “Psychoanalytic Investigation of and Therapy in the Border Line Group of Neuroses.” Psychoanalytic Quarterly, 7: 467-489.

Stern, D. N. (1985/1998). The Interpersonal World of the Infant: AS View from Psychoanalysis and Developmental Psychology. London: Karnac.

Strenger, C. (1998). “The desire for self creation.” Psychoanalytic Dialogues. Sullivan

Strozier, C. B. (2001). Heinz Kohut: The Making of a Psychoanalyst. New York: Farrar, Straus & Giroux.

Sullivan, H.S. (1956). Clinical Studies in Psychiatry. New York, Norton.

Tronick, E. Z., Als, H., Adamson, L., Wise, S., & Brazelton, T. B. (1978). “The infant’s response to entrapment between contradictory messages in face-to-face interaction.” Journal of the American Academy of Child and Adolescent Psychiatry, 17: 1-13. Reprinted in: Tronick, E. Z., The Neurobehavioural and Social-Emotional Development of Infants and Children (pp. 262-273). New York: Norton, 2007.

Tronick, E. Z., Bruschweiler-Stern N., Harrison A. M., Lyons-Ruth, K., Morgan A. C., Nahum J. P., Sander, L., & Stern, N. D. (1998). “Dyadically expanded states of consciousness and the process of therapeutic change.” Infant Mental Health Journal, 19: 290-299. Reprinted in: Tronick, E. Z., The Neurobehavioural and Social-Emotional Development of Infants and Children (pp. 402-411). New York: Norton, 2007.

Tronick, E. Z., & Gianino, A. (1986). “Interactive mismatch and repair: challenges to the coping infant. Zero to Three, Bulletin of the National Center for Clinical Infant Programs, 5: 1-6.” Reprinted in: Tronick, E. Z., The Neurobehavioural and Social-Emotional Development of Infants and Children (pp. 155-163). New York: Norton, 2007.

van der Kolk, B. (1996a). “The complexity of adaptation to trauma: self-regulation, stimulus discrimination, and characterological development.” In: A. C. McFarlane, L. Weisaeth & B. van der Kolk (Eds.), Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society. (pp. 182-213). New York: Guilford Press.

van der Kolk, B. (1996b). “Trauma and memory.” In: A. C. McFarlane, L. Weisaeth & B. Van der Kolk (Eds.), Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society (pp. 279-302). New York: Guilford Press, 1996.

van der Kolk, B. (2005). “Developmental trauma disorder: toward a rational diagnosis for children with complex trauma histories.” Psychiatric Annals, 35: 401-408.

van der Kolk, B. (2014). The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma. Harmondsworth: Penguin.

van der Kolk, B., & d’Andrea, W. (2010). “Towards a developmental trauma disorder diagnosis for childhood interpersonal trauma.” In: R. Lanius, E. Vermetten & C. Pain (Eds.), The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic (pp. 57-68). Cambridge: Cambridge University Press.

van der Kolk, B., Greenberg, M., Boyd, H., & Krystal, J. (1985). “Inescapable shock, neurotransmitters, and addiction to trauma: toward a psychobiology of post-traumatic stress.” Biological Psychiatry, 20: 314-325.

van der Kolk, B., & McFarlane, A. C. (1996). “The black hole of trauma.” In: B. van der Kolk, A. McFarlane & L. Weisaeth (Eds.), Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society (pp. 3-23). New York: Guilford Press.

van der Kolk, B., McFarlane, A., & van der Hart, O. (1996). “A general approach to the treatment of posttraumatic stress disorder.” In: B. van der Kolk, A. McFarlane & L. Weisaeth (Eds.), Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society (pp. 417-440). New York: Guildford Press.

van der Kolk, B., McFarlane, A. & Weisaeth, L. (1996). Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society, B. van der Kolk, A. C. McFarlane & L. Weisaeth (Eds.). New York: Guilford Press.

van der Kolk, B., Weisaeth, L, & van der Hart, O. (1996). “History of trauma in psychiatry.” In: B. van der Kolk, A. C. McFarlane & L. Weisaeth (Eds.), Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society (pp. 47-76). New York: Guilford Press.

Vermetten, E., Dorahy, M. J., & Spiegel, D. (Eds.) (2007). Traumatic Dissociation Neurobiology and Treatment. Washington, DC: American Psychiatric Press.

West, M. (2004). “Identity, narcissism and the emotional core.” Journal of Analytical Psychology, 49: 521-552.

West, M. (2007). Feeling, Being and the Sense of Self: A New Perspective on Identity, Affect and Narcissistic Disorders. London: Karnac.

West, M. (2008). “The narrow use of the term ego in analytical psychology: the “not-I” is also who I am.” Journal of Analytical Psychology, 53: 367-388.

West, M. (2010). “Envy and difference.” Journal of Analytical Psychology, 55: 459-484.

West, M. (2011). Understanding Dreams in Clinical Practice. London: Karnac.

West, M. (2013a). “Trauma and the transference-countertransference: working with the bad object and the wounded self.” Journal of Analytical Psychology, 58: 73-98.

West, M. (2013b). “Defences of the core self: borderline functioning, trauma, and complex.” In: A. Cavalli, L. Hawkins & M. Stevns (Eds.), Transformation: Jung’s Legacy and Clinical Work Today (pp. 131-154). London: Karnac, 2013.

West, M. (2014). “Trauma, participation mystique, projective identification and analytic attitude.” In: M. Winborn, (Ed.) Shared Realities: Participation Mystique and Beyond (pp. 51-69). Cheyenne, WY: Fisher King Press.

West, M. (2016). “Working in the borderland: early relational trauma and Fordham’s analysis of “K”.” Journal of Analytical Psychology, 61: 44-62.

West, M. (2016). Into the Darkest Places: Early Relational Trauma and Borderline States of Mind. London: Karnac, 2016.

Widiger, T. A., and S. N. Mullins-Sweatt. (2005). Categorical and dimensional models of personality disorders. In The American Psychiatric Publishing textbook of personality disorders. Edited by J. M. Oldham, A. E. Skodol, and D. S. Bender, 35-53. Arlington, VA: American Psychiatric Publishing.

Widiger, T. A., and S. N. Mullins-Sweatt. (2009). Five-factor model of personality disorder: A proposal for DSM-V. Annual Review of Clinical Psychology 5:115-138.

Winckler, M.M.(1995). Obsessionalism. In M.Lionells, J. Fiscalini, C.H. Mann & D.B. Stern (Eds.) Handbook of Interpersonal Psychoanalysis, (pp. 469-490) Hillsdale NJ: The Analytic Press.

Winnicott, D. W. (1953). “Transitional objects and transitional phenomena-a study of the first not-me possession.” International Journal of Psychoanalysis, 34: 89-97.

Winnicott, D. W. (1960). “Ego distortion in terms of true and false self.” In: Winnicott, D. W., The Maturational Processes and the Facilitating Environment: Studies in the Theory of Emotional Development. (pp. 140-152). London: Hogarth, 1965.

Winnicott, D. W. (1964). “Memories, Dreams, Reflections: by C. G. Jung.” International Journal of Psychoanalysis, 45: 450-455.

Winnicott, D. W. (1967). “The location of cultural experience.” International Journal of Psychoanalysis, 48: 368-372.

Winnicott, D. W. (1969). “The use of an object.” International Journal of Psychoanalysis, 50: 711-716.

Winnicott, D. W. (1974). “Fear of breakdown.” International Review of Psychoanalysis, 1: 103-107.

Winson, J. (1990). “The meaning of dreams.” Scientific American, November: 86-96.

Wirtz, U. (2014). Trauma and Beyond: The Mystery of Transformation. New Orleans, LA: Spring Journal.

Wink, P. (1991). “Two faces of narcissism.” Journal of Personality and Social Psychology, 61: 590-597.

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1877 – Jean-Martin Charcot, at the Salpêtrière Hospital in Paris, was the leading physician of his day working on nervous disorders and, in particular, hysteria (he has also been called the founder of modern neurology). He was the first to make the link between hysteria and underlying trauma (Lectures on the diseases of the nervous system: Delivered at La Salpêtrière, 1877).

1894 – Charcot’s work on hysteria was taken up and much developed by his pupil, Pierre Janet, who laid down the foundation stones of trauma theory which are still sound today. Through extensive study, observation, and the use of hypnosis, Janet concluded that dissociation was the characteristic underlying mechanism behind hysteria. He proposed that a traumatic event gives rise to “vehement emotions” in the individual which cannot be integrated with their existing cognitive schemes and are thus split off-dissociated. The memory traces of the trauma remain in the form of what Janet called “fixed ideas”-idées fixes-in the mind of the individual. These are thoughts or mental images that take on exaggerated proportions and have a high emotional charge (Janet, 1894). They are not integrated with the normal personality and they disrupt normal consciousness.

1898 – Havelock Ellis was the first psychologist to clinically use the term “Narcissus-like”, linking the figure in Ovid’s myth to the condition of auto-eroticism (i.e., self as own sexual object) in one of his patients.Auto-eroticism: A psychological study

1899 – Paul Nacke introduced the term “narcissism” in a study of sexual perversions, drawing on Ellis’s work on “morbid self love” and his correlation of the Greek myth of Narcissus with a case of “male autoerotic perversion.” Die sexuellen Perversitäten in der Irrenanstalt

1908 – Karl Abraham analysed what was later described as destructive narcissism (Rosenfeld), where envy promotes narcissism and retards object-love.

1911 – Otto Rank wrote one of the first psychoanalytical papers specifically concerned with narcissism, linking it to vanity and self-admiration. A contribution to narcissism.

1914 – Sigmund Freud published his pivotal paper ‘On narcissism: An introduction‘, discussing narcissism from a more developmental perspective. Freud argued that narcissism was a normal maturational phase of healthy development in all children (“primary narcissism”) and a “complement to the egoism of the instinct for self-preservation”. Healthy development, for Freud, “consists in a departure from primary narcissism”, a departure in which people invest their libidinal energy into another person rather than themselves.

1932 – In his seminal ‘Confusion of tongues‘ (1932) paper, Ferenczi introduced the concept of identification with the aggressor, which was seen as a way of the child keeping safe and keeping the abusive parent as a good figure. Fairbairn was later to call this a moral defence, ‘I am bad so you (can remain) good’. Ferenczi’s insistence on the centrality of real world trauma was one of the reasons he fell out with Freud.

1938 – Adolf Stern. The first detailed description of the borderline case is found in Stern’s paper, ‘Psychoanalytic Investigation of and Therapy in the Border Line Group of Neuroses‘ (1938), and Stern is often regarded as the father of the term ‘borderline personality’. “It is well known,” he writes, “that a large group of patients fit frankly neither into the psychotic nor into the psychoneurotic group, and that this border line group of patients is extremely difficult to handle effectively by any psychotherapeutic model”.

1952 – William Fairbairn made significant contributions to understanding issues of dependency, splitting, and the importance of object relations in clients with borderline traits (see Celani, 1993). As Celani notes, “Fairbairn made the brilliant and counterintitutive observation that children that were neglected or abused were more rather than less dependent on their parents.” See Fairbairn’s Psychoanalytic Studies of the Personality, and his papers ‘Schizoid factors in the Personality’ (1940); ‘A revised Psychopathology of the Psychoses and Psychoneuroses’ (194l); ‘The Repression and the Return of Bad Objects’ (1943); ‘Endopsychic Structure Considered in terms of Object Relationships’ (1944).

1971 – Heinz Kohut (1966, 1968, 1971, 1972) wrote extensively on narcissism, and like Freud he believed that narcissism was a healthy and normal part of development and “neither pathological nor obnoxious” (1966). However, unlike Freud, he believed that primary narcissism was a state of undifferentiated union with the mother, rather than a state of total self-absorption: “the baby originally experiences the mother and her ministrations not as a you and its actions, but within a view of the world in which the I – you differentiation has not yet been established”. From this state he posited two separate developmental trajectories of focus on self and other. The Analysis of the Self.

1975 – Otto Kernberg first introduced the term ‘borderline personality organisation’ to refer to a consistent pattern of functioning and behaviour characterised by instability and reflecting a disturbed psychological self-organisation (‘Borderline Conditions and Pathological Narcissism‘, 1975), and as Marcus West suggests, he is “probably the psychoanalytic theoretician most associated with this concept” (West, 2016).

Kernberg also wrote extensively on narcissistic disorders, believing they were a subtype of borderline personality disorders (Kernberg, 1975): “These patients present an unusual degree of self-reference in their interactions with other people, a great need to be loved and admired by others, and a curious apparent contradiction between a very inflated concept of themselves and an inordinate need for tribute from others. Their emotional life is shallow. They experience little empathy for the feelings of others, they obtain very little enjoyment from life other than from the tributes they receive from others or from their own grandiose fantasies, and they feel restless and bored when external glitter wears off and no new sources feed their self-regard.” Many elements of this definition were later used to help create the diagnostic criteria for Narcissistic Personality Disorder in the DSM-III. Borderline Conditions and Pathological Narcissism.

1979 – In his best-selling book The Culture of Narcissism the American historian Christopher Laschidentified what he termed a “culture of narcissism” in post-war America, suggesting that the individual self had become weakened and infantilised by consumer society, which prolongs the experience of infantile dependence into adult life, surrounding us with “fantasies of total gratification”. As author and psychotherapist Sue Gerhardt comments, “Lasch believed that modern capitalist society reinforced narcissistic traits in everyone, and allowed ‘celebrities’ with narcissistic personalities to set the tone of public and private life” (The Selfish Society, 2010). The generation of such narcissistic traits in capitalist societies, Lasch argued, was the psychological outcome not of any innate self-preoccupation or potency, but was instead a reflection of our lack of real social or political power: “In its pathological form, narcissism originates as a defense against feelings of helpless dependency in early life, which it tries to counter with ‘blind optimism’ and grandiose illusions of personal self-sufficiency”.

1985 – Daniel Stern‘s influential work The Interpersonal World of the Infant (1985), challenged, and offered detailed material to counter Freud’s position of Primary Narcissism.

1987 – In Impasse and Interpretation (1987), Herbert Rosenfeld describes destructive narcissism and narcissistic omnipotent object relations, as well as the concepts of thick- and thin-skinned narcissism. A classic book.

1991 – Peter Fonagy‘s (1991 & ff.) work on borderline phenomena and his integration of attachment theory has been particularly significant in recent years. See for example, Fonagy, ‘Thinking about thinking: some clinical and theoretical considerations in the treatment of a borderline patient’ (1991).

1992 – Judith Herman‘s work on trauma experienced by women, and her coining the concept of complex PTSD, was very important; Trauma and Recovery (1992)

1996 – Bessel Van der Kolk is another major figure in recent discussions of trauma and dissociation; see for example Traumatic Stress (1996), co-authored with McFarlane & Wisaeth.

2003/2004 – Ron Britton‘s classic paper on narcissism (‘Narcissistic disorders in clinical practice’, 2004) and his work in Sex, Death and the Superego (2003), delineates different kinds of narcissism and distinguishes it from hysteria (as do Bollas (2000) and Andre Green (1997)), particularly distinguishing libidinal narcissism from destructive narcissism, which he links back to Karl Abraham’s (1908) understanding of envy promoting narcissism and retarding object-love (predating Freud’s conceptualisation).

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‘Borderline’ and ‘Narcissistic’: The problem with terms

The influential American diagnostic manual, the DSM, provides diagnostic criteria for what it terms ‘narcissistic personality disorder’ and ‘borderline personality disorder’, yet the whole concept of regarding personality traits as ‘disorders‘ has met with fierce criticism in recent years, amongst both patients and analysts. Some regard the concept of psychological ‘disorders’ as reinforcing an unnecessary and inappropriate medical diagnostic model; some see it as being rooted in a limiting post-Enlightenment ideology of rigid classification and marginalisation of anyone not deemed to be suitably socially acquiescent (see Richard Bentall, 2004; Foucault, 1961); and many patients themselves regard the concept of ‘personality disorder’ as both stigmatising and reinforcing a stereotypical and reductive image of who they are: as Rachel Rowan Olive has recently remarked, “My personality is who I am. You cannot tell me my very self is disordered and then convince me you do not want to reduce me to a stereotype” (Olive, 2018).

For these reasons, there has been a move to drop the term ‘disorder’ in recent years and replace it with less stigmatising and rigid concepts, such as ‘distress’, or simply ‘personality traits’. As Mollon suggests, the term ‘disorders’ at best simply denotes the presence of certain enduring identity disturbances, fluctuating moods, and disruptions (Link to Talk).

The specific terms ‘borderline‘ and ‘narcissistic‘ are also far from ideal. The term ‘borderline’, for instance, originated in Adolf Stern’s well-meaning but confusing description of individuals who seemed to be on the ‘border’ between neurosis and psychosis, a view that is no longer maintained but whose name curiously survives. Patients when diagnosed as ‘borderline’ often feel they must therefore be living in some sort of hinterland, between insanity and sanity, or other states, or on the edge of categories. For those with an already fragile sense of identity this is clearly unhelpful.

There is an ongoing debate about re-naming the disorder both because of its clinical confusion and because it may inadvertently stigmatise those with it: one solution proposed has been to rename it as ’emotionally unstable personality disorder’, in order to distance itself from the ‘borderline’ connotations, but creating perhaps its own problems.

The term ‘narcissistic’ is also rather problematic and open to misunderstanding, due in part to the fact that the clinical description is in many ways very different from ‘popular’ ideas about narcissism, which usually simply denote ‘self-love’. This fails to convey the deep narcissistic wound that the ostensibly self-admiring and grandiose self seeks to cover and distract itself from.

Is narcissism a defensive (compensatory) strategy or a fundamental drive?

Perhaps one of the deepest theoretical divisions in analytic literature on narcissism has centred on whether clinical ‘narcissism’ can be considered as an innate/primary personality trait or one acquired as a defensive or protective response, for example to early childhood trauma or neglect. Freud believed that narcissism was a primary state, something we are all born with, and an inevitable feature of the self-involved world of the infant – ‘His Majesty, the Baby’, as he influentially categorised this form of internalised self-libido (Freud, 1914).

But others have seen narcissism not as something innate but as a defensive response to unbearable early neglect, humiliation, or distress. The self-love associated with narcissism, Neville Symington suggests, is “merely a compensation, not a developmental drive, as Freud and his followers believed” (Link to Talk). The important psychoanalytical concept of the ‘narcissistic wound’ would also seem to suggest that this is not an innate or primary state, but the result of something done to us, which we then mirror and internalise. As Lasch notes, “In its pathological form, narcissism originates as a defense against feelings of helpless dependency in early life, which it tries to counter with ‘blind optimism’ and grandiose illusions of personal self-sufficiency” (Lasch, 1973; see also Fordham, 1974).

In this sense, narcissism might more properly be understood not as an expression of self-love, but the very opposite. Behind the apparent grandiosity and absorption with self-image there is always an intense absence of love, a lack of power and efficacy, which the generation of a narcissistic, grandiose ‘self’ seeks to desperately compensate for, stepping in to try and prevent the identity from collapsing completely. “Because they are damaged and fearful,” note Abse and Riddell, individuals with narcissistic traits “feel that the only safe way to operate is to put themselves at the centre of their universe”. Such ‘narcissism’ is therefore felt as a “justified protest” at potential abuse by the other: if they didn’t behave ruthlessly, or grandiosely, they’d be done for by the other. Narcissism would then be understood as “a defensive mode of relating, designed to protect the self from threatened pain” – from the knowledge and experience of intense shame and vulnerability.

Whereas in popular culture, narcissistic personalities are often seen in terms of simple megalomania, perhaps a wider understanding of the defensive aspect of Narcissus would help us engage with the deeper and more troubled roots of the personality.

Is narcissism healthy?

Related to the discussion about whether narcissism is a primary ‘developmental drive’, as Freud and some of the earlier psychoanalysts speculated, or a pathological state arising as a defensive response to early attachment disturbance and disorganisation, is the question of whether there is such a thing as ‘healthy narcissism’. In his influential 1914 paper ‘On Narcissism’ Freud observed that “it seems very evident that another person’s narcissism has a great attraction for those who have renounced part of their own narcissism and are in search of object love.” These ideas were developed in the 1960s by Kohut, who claimed that a “normal narcissism” was the wellspring of human ambition, creativity, and empathy.

The attractiveness of narcissistic traits in certain cultures has also been a recurrent theme in many books on the subject, such as Lasch’s 1973 examination of the ‘narcissistic’ elements in modern consumer culture, and Elizabeth Lunbeck’s more recent analysis in ‘The Americanization of Narcissism’ (2014). Loving one’s self is often regarded as a healthy and attractive trait, and something actively encouraged in many contemporary cultures, especially perhaps in America and western Europe, as Lasch and Lunbeck suggest.

However, other analysts have regarded the notion of ‘healthy narcissism’ as something of an oxymoron, one that blurs popular misconceptions about ‘narcissism’ with a more problematic and precise clinical understanding. As we have seen, there is considerable research suggesting that narcissism is a compensatory response to an overwhelming sense of shame, rooted in the ‘narcissistic wound’: it is hard to think of a ‘healthy’ version of this. It is also perhaps significant that Freud associated primary or ‘normal’ narcissism with what he called “self-contentment and inaccessibility” in infants, perhaps suggesting a confusion between concepts of “self-contentment” or even simply “enjoyment” with that of grandiose self-isolation. A state of self-contentment and inaccessibility resembles in many ways the positive state that mindfulness practice and spiritual traditions seek to realise. As Mollon notes, Freud also perhaps perversely saw evidence of ‘narcissism’ not only in the happiness of children but also in animals, beautiful women (who “develop a certain self-contentment”) as well as in many “primitive peoples”, as he put it – comments that perhaps suggest the complex ways in which libido and eros is viewed with such intense suspicion and perhaps envy by the ‘reality principle’ in modern societies. “The charm of a child”, wrote Freud, “lies to a great extent in his narcissism, his self-contentment and inaccessibility, just as does the charm of certain animals which seem not to concern themselves about us, such as cats and the large beasts of prey. It is as if we envied them for maintaining a blissful state of mind-an unassailable libidinal position which we ourselves have since abandoned” (On Narcissism, 1914).

There is also the long-standing debate about whether the infant does go through a stage of Primary Narcissism, withdrawn from object relationship and in a state of hallucinatory wish fulfilment, or whether, as Klein held, the child is object related from the beginning. Margaret Mahler’s understanding of child development reflects Freud’s original conceptualisation, whilst later researchers, from Daniel Stern (in his classic book The Interpersonal World of the Infant), to Ed Tronick and Beebe and Lachmann have shown that the child does indeed engage with others from the beginning of life.

It is worth noting that Klein didn’t much use the concept of narcissism but, as Hanna Segal put is, the paranoid-schizoid position is the narcissistic position – see Hinshelwood’s A Dictionary of Kleinian Thought(1988) for a full discussion of this.

This also relates to the issue of whether the behaviour is understood to be largely self-generated or innate – viz. Freud’s primary narcissism or death instinct or Klein’s innate envy and destructiveness (also related to the death instinct), or whether the narcissistic or borderline phenomena relate to real world experience viz. Bowlby, contemporary trauma theory (such as van der Kolk), relational psychoanalysis and Fonagy.

Krystal (1978) argued that Freud held two theories concurrently, one emphasising the role of trauma and the other emphasising the individual’s innate conflicts over, for example, their infantile sexuality. It is certainly the latter view that held sway for much of the 20th Century in psychoanalytic circles, although the Middle Group of Analysts (Winnicott et al.) held an intermediate position (see West, 2016). The whole concept of the death instinct was also contentious and was one that Winnicott and the middle school also ‘tempered’.

These are not merely theoretical debates but will also influence the analyst’s attitude to the patient – for example, whether they think a particular instance of behaviour might be due to the patient’s destructiveness and intent to harm the analyst, or whether it is seen as a communication and a reconstruction or co-construction of the patient’s own early experience which this ‘enactment’ brings clearly to light.

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The main treatment for individuals with borderline and narcissistic personality traits is centred on various forms of psychotherapy, including Cognitive Behavioural Therapy (CBT) and Dialectical Behaviour Therapy (DBT). Contemporary treatments commonly involve mentalization-based therapy, transference-focused psychotherapy, and schema-focused psychotherapy. Individual and group psychotherapy may be also useful in helping people with narcissistic and borderline personality disorders.

Indeed, the success of psychotherapeutic treatments for individuals with borderline and narcissistic personality traits is one of the most striking developments that has happened in the analytic world since Freud’s original formulations in 1914. Whereas Freud regarded narcissistic traits as largely untreatable in the psychoanalytic setting and as an obstacle to psychoanalysis, in the second half of the 20th century object relation theorists (both in the United States and among British Kleinians) set about revaluing these traits as defence mechanisms that offered potential access for therapy. The pioneering work of Kohut, Kernberg, Fairbairn, Rosenfeld, McWilliams, and others has shed invaluable light on both the aetiology and treatment of these complex disorders.

Potential difficulty of treatment

One of the initial obstacles to treatment is the fact that many individuals with these personality traits often do not consider themselves to have a problem, due to the peculiar self-recognition difficulties inherent in these specific psychologies. In the past, some therapists have also viewed such patients as being simply too complex or difficult to treat, and may therefore have directly or indirectly excluded those with such diagnoses or associated behaviours from effective treatment.

Therapists can also become disheartened by lack of initial progress, or by apparent progress that then leads to setbacks. Clients may be perceived as manipulative, difficult to manage, noncompliant, aggressive, and attention-seeking (Jack Nathan Talk). These behaviours may in turn invoke hostility in those treating these individuals, and they can therefore be dealt with more negatively and dismissively as a result, creating an unhelpful negative feedback loop.

However, as Celani observes, if the therapist is aware of these characteristics, and the personality structures and mechanisms underlying them, psychotherapeutic treatment can be successful, and in many instances rewarding. Indeed, the diagnosis of ‘borderline’ is often today considered ‘the good prognosis diagnosis’, in that people do get better and recovery can be sustained. As Kernberg (2012) concludes, “BPD is an eminently treatable disorder, and patients can be helped”. In the case of BDP, it is estimated that up to fifty percent of patients improve over a ten-year period.

Treatment for individuals with narcissistic traits can be especially challenging because many people with this condition often present with a great deal of grandiosity and defensiveness, again making it difficult for them to acknowledge problems and vulnerabilities. Steiner observes that many such patients are also considered hard to treat as they have such difficulty relating to others, are inward-looking, and detached from ‘objects’, making the therapeutic transference hard to form (this was Freud’s view). However, notes Steiner, the transference can actually be “extremely intense” with this personality group: though they might superficially appear to be ‘cut off’ from the therapist, patients are often acutely observant of them, and affected by them (Steiner, 1993).

Those with pathological or ‘malign’ narcissism may also resist treatment due to the fact that they are peculiarly sensitive to being seen as small, dependent, or grateful – arousing in them problematic notions of ‘progressing’, or of being seen as ‘good’. The internalised sense of being inherently worthless or empty may serve in these instances as a defensive function, and as such any attempt to challenge it may be ruthlessly attacked and torn down (Steiner, 1993). In this precarious mind-set the very idea of ‘therapy’ can be humiliating. It is important to remember that shame is the core affect in narcissistic disturbance – an acute sense of feeling inadequate, which any attempt at self-development, self-discovery, or self-improvement might trigger or provoke. As Neville Symington observes, “Effective therapy must acknowledge these immaturities and face the humiliation and rage their exposure provokes. It then becomes possible for narcissistic traits like greed and envy to be transformed into their positive relational counterpart such as receptivity and respect” (Link to Talk).

It is for these reasons that Nathan advocates a ‘Benign Authority’ model of treatment, involving an empathic approach, setting boundaries and limits, being alert to the therapeutic role in tolerating the counter-transference, and “being actively emotionally involved” (Link to Talk). He notes that in some senses this approach might run counter “to ideas of neutrality” in the analyst, but he points out that where sensitivity to ‘abandonment’ can be so strong in the patient, being ‘neutral’ can all too readily be taken for rejection. As Mollon similarly notes, working constructively with these personality traits “requires empathy, tact, and truth” (Link to Talk).

One of the central aims of treatment is for the ‘central ego’ of the patient to become dominant and not be sabotaged by the Anti/Libidinal Egos, and their Good/Bad Objects (Link to Talk). A positive treatment can see a significant reduction of hatred towards the Rejected Object.

Celani notes that different therapeutic relationships are created by different therapeutic models. He lists four steps that are helpful for all approaches:

1. Become a good object (for the patient). “Listening turns you into a good object.”
2. Gently unearth bad object memories – i.e. without commenting on them at the outset of therapy.
3. Engaging in direct contact with the sub-structures – i.e. knowing what they are, and not making them worse (for example, working on the AntiLibidinal Ego, not the Libidinal Ego).
4. Supporting the re-establishment of development.

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The causes and aetiology of both borderline and narcissistic personality traits are complex and not fully agreed on. They involve genetic, brain, environmental, and social factors. However, both are strongly linked with insecure attachment (particularly disorganised attachment), early developmental issues, and issues of identity formation and ‘personality’ (see McWilliams, 1990).

Developmental and relational aetiology

In his pioneering book Into the Darkest Places: Early Relational Trauma and Borderline States of Mind (2016), Marcus West describes borderline personality states as being rooted in “early relational trauma”, and therefore require “an integration of analytic theory, trauma theory, and relational theory” for successful treatment. Similarly, while the precise aetiology of narcissistic personality types is unclear, there seems to be a strong association and alignment with early developmental and relational disruptions: child neglect, or child abuse, show up as significant risk factors, as does socioeconomic status, and there is a strong association with erratic or dysregulating parental care.

Early developmental disruptions to the sense of self might be generated by:

• emotional, physical, and sexual abuse and/or neglect by the care-giver
• excessive praise and overindulgence, or narcissistic over-stimulation by the care-giver
• unpredictable or inappropriate responses (lack of realistic feedback)
• manipulative parents (for example, where their children are used to regulate their own self-esteem or narcissistic issues).

All of these experiences may generate significant and enduring disruptions in the way the child is being seen and attended to, which the child then internalises and models, as well as causing severe damage to their ability to emotionally and cognitively self-regulate.

There is a growing appreciation of the role of early relational trauma in borderline states of mind in particular (Herman; Perry; van der Kolk, 1989), and indications that BPD may overlap with complex PTSD (see Herman; also Fonagy et al, 1991, 2008). In terms of the importance of early trauma in the aetiology of narcissistic and borderline traits, Freud, Klein, and Jung tended to focus more on the “inner trauma” (structures, drives, etc), while Ferenczi, Bowlby, Seligman, and Rosenfeld have drawn attention to the “real-world trauma” as the crucial dynamic, a social and contextual focus that was often marginalised in early psychoanalytic thinking.

There have been various speculations as to how the psyche protects itself against narcissistic wounding (wounds to the core of the self) by throwing up narcissistic, borderline, hysteric, and schizoid defences which then become incorporated and rigidified into personality organisations (see Marcus West, 2016). In this sense, both borderline and narcissistic traits can be seen as “primitive defensive reactions” to early trauma or parenting disruptions.

Narcissistic disturbances can be generated in infancy through a number of particularly disrupting and dysregulating parenting approaches, including ignoring or shaming the child’s initiatives; making parental love highly conditional (e.g., rewarding only behaviour that support’s mothers image of the child, or discouraging contact with the father, so the child is trapped in a dyad); encouraging the child’s grandiosity, or sense of ‘specialness’; rejecting, abusing, or neglecting the child (which can generate cycles of entitlement, and grievance); and nurturing pro-narcissistic defences.

In borderline instances, reversals or ‘splittings’ are common in this early developmental situation, with the infant identifying both as ‘subject’ (to the trauma), and in reversed form, in identification with the ‘aggressor’. This latter role is often later projected onto a new partner (or parental figure), thus re-binding them to the object. “This reversal of the original experience is one of the elements that causes the conflict characteristic of borderline functioning, both alienating the individual from themselves and preventing the development of a coherent identity” (Marcus West, 2016).

Recognising the various “internal working models” generated by the trauma, and accepting them on various levels (relational, internal, historical, and archetypal), is considered a highly effective therapeutic way of helping the individual to manage and integrate these internal disruptions. As van der Kolk notes, “Trauma is, by definition, an experience which the individual psyche cannot bear, contain, or integrate at that time” (van der Kolk, 1996b).

Attachment and Affect Regulation

Mucci has observed that “inconsistent attachment is an important element in the aetiology of the disorder” (Link to Talk). This again points to the crucial role that early relational issues play in the development of these pathologies: issues of attachment, relationship, and the lack of sufficient emotional and ontological attunement. Alan Schore’s pioneering developmental model (interpersonal neurobiology, or ‘IPNB’) in these early relationships is especially helpful in better understanding the mechanisms involved, and how they manifest as incapacity to regulate, as well as generating negative affect and low self-esteem.

Disruptions to the sense of self that are not successfully regulated by the mother or primary caregiver can lead to the formation of a ‘fragile’ self, as well as to a lack of cohesion of the self. As Mucci explains, this inconsistent mothering can disrupt the infant’s early affect regulation: “Narcissistic mothers are more concerned with their own emotional needs than the child’s”, which may result in both under-stimulation of the infant and also “a kind of over-stimulation” or “hyper-arousal”. In these instances, “mothers are intrusive and controlling instead of mirroring and containing”. Thus, in the separation/individuation phase, the mother ‘rewards’ the child’s growth only in relation to her own needs: when the child is in a positive, grandiose state, mirroring her own narcissistic needs, the mother is emotionally accessible, but does little to modulate and contain the child’s affect. The mother can either ‘fail to modulate’ the infant, or may hyper-stimulate it. Mucci shows how these failures of modulation can manifest on a neurobiological level as significantly increased levels of cortisol in the infant, which may impair and indeed damage the child’s developing immune system (Link to Talk).

The attachment aspect to borderline and narcissistic traits was outlined by Fairbairn in his important analytic and theoretical contributions. In Fairbairn, Freud’s early ‘libidinal’ theory is replaced by a more relational or attachment theory: narcissism is not seen as a fundamental drive (e.g., a drive for release, or to discharge), but rather as a desire for an object, one that is the key to the aetiology (the infant wants comfort, nurturing, safety).

As Celani remarks, attachment is paramount in Fairbairn’s model as he recognised that children are absolutely and unconditionally dependent on their parents (Link to Talk).

Structural models

Mollon also explores the deep structures of these states and their developmental origins, questioning the very nature of ‘self’, and exploring the illusory identities that often structure our experience. He notes that malign narcissism that can sometimes reside within the psychotherapeutic endeavour itself: by understanding the precise internal structure of narcissism, and how it imprisons the person in its illusions, he shows how therapists may be better positioned to help (rather than further injure) the client who presents with these problems (Link to Talk).

Celani examines and draws on the psychoanalytic theory of object relations in his penetrating analysis of borderline and narcissistic types, showing how object relations theory is a particularly helpful structural theory in these cases. At the heart of his model is a structural theory that organizes relational events into three ‘self-and-object’ pairs: one conscious pair (the ‘central ego’, which relates exclusively to the ‘ideal object’ in the external world) and two mostly unconscious pairs (the child’s ‘antilibidinal ego’, which relates exclusively to the ‘rejecting’ parts of the object; and the child’s ‘libidinal ego’, which relates exclusively to the ‘exciting’ parts of the object; see Link to Talk). The significant role of ‘objects’ is highlighted in the mental structure of these identities, focusing on the structural mechanisms of dissociation and repression:

See CELANI’S 6-box Diagram:

Celani shows how these are shifting states: the patient can shift from one to another, denying the previous state, which can be confusing for the therapist who is not aware of this mental structure. As he suggests, Fairbairn’s central defence mechanism, splitting, is the first shift from ‘central ego’ dominance to either the libidinal ego or the antilibidinal ego.

The ‘thick-‘ and ‘thin-skinned’ aspects of narcissism are also elaborated on in the role of projective identification in these narcissistic states:

THIN (Acquisitive Projective Identification) – i.e. ‘You are me’ (in order to get rid of the ‘otherness’ of the other)
THICK (Attributive Projective Identification) – i.e. ‘I am you’ (to get rid of the need for the other)

Neuroscientific understandings of borderline and narcissistic structures and processes

Psychotherapist and clinical psychologist Clara Mucci has outlined those areas of the brain involved in the regulation of stress responses and emotion (hippocampus, orbitofrontal cortex, and amygdala), and how these are significantly affected in narcissistic and borderline disturbances. She shows how in these instances the orbitofrontal circuit system down-regulates mood and affects, such as regulation of self-esteem. A neurobiological model helps to illustrate how, due to the intense stress of early narcissistic injury, the developing brain cannot mature at its best due to this lack of essential self-attunement. Neuroscience also supports and illuminates a psychoanalytic approach whereby traumatic experiences that are not integrated by the ego remain as dissociated, highly charged somatic-affective fragments (see van der Kolk et. al, Traumatic Stress, 1996) which return as flashbacks and as key elements in the transference / analytic relationship. This coheres exactly with Jung’s concept of the traumatic complex (see West, 2016).

Mizen has examined the disorganised relational aspect of narcissistic and borderline traits, developing a ‘relational-affective model’. She explores “failures of symbolic functioning” though an incorporation of Panksepp’s pioneering research in affective neuroscience, showing how these disorganised relations manifest in two specific areas of the brain:

• lateralised – RH frontoparietal network (i.e. the embodied relational self- see Schore)
• medial – the default mode (conscious, abstract, evaluative self).

Issues of Image and Identity

Holmes has suggested that in the early aetiology of narcissism, the infant comes to identify with the observer of the self, getting ‘trapped ‘in the other’s gaze, which then becomes a repetition of this other. In this way, Holmes draws our attention again to narcissism as a developmental process, revealing the precarious process by which we try to develop a sense of self, a sense of self-belief, and a sense of agency – and the many possible disruptions to this process. See also Fonagy, Gergely, Jurist and Target’s (2002) understanding of the internalisation of the abusive other forming an alien self that cannot function in an integrated or well-adapted way.

This sense of being ‘trapped’ or fixated on another’s image of oneself is of course an aspect of the original myth of Narcissus, where it was also linked to an underlying theme of self-knowledge (in the story, Tiresias’s prophecy regarding the youth was that he would only live a long time “If he shall not know himself”). But as Holmes suggests, “Narcissus can never really know himself, as he cannot take a position outside himself’ – that is, he cannot ‘see’ himself accurately, as another does. For the same reason, Holmes notes, the Narcissus breaks hearts: he ‘cannot see’ his effect on others – the impact of his actions. Narcissists also attract other narcissistic people, perhaps hoping for ‘reflected’ glory: again, it’s all about sight, about being seen.

Mollon shows how this excessive investment in image (self-image) profoundly obstructs emotional growth and development, and relationships with others (see also Kernberg, and Kohut). Indeed, Kernberg regards this formation of a ‘grandiose self’ as a pathological fusion of the image of the real self, ideal self, and idealised other.

Mollon speaks movingly about what it might be like for an infant to be trapped or imprisoned in the distorting mirror of the mother’s or primary care-giver’s narcissism. He notes that differentiation of one’s self is “a crucial developmental achievement”, but that we are all, always, entangled in relationships and dependencies, and therefore vulnerable to a wide range of disruptions and fragmentation in our developing sense of agency, efficacy, and self-coherence (Link to Talk).

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Narcissistic and borderline personality traits are rooted in a particularly unstable or ‘fragile’ sense of self, as the title of Phil Mollon’s classic 1993 work on these specific types of personality suggests (The Fragile Self: The Structure of Narcissistic Disturbance‘), one that is often organised around early forms of disorganised attachment. This sense of internal and relational instability can manifest as rapidly alternating emotional moods and behaviours, with the individual characteristically switching between states of idealisation and denigration of others, and feelings of both grandiosity and emptiness. Often these disruptive moods and behaviours centre on, or are triggered by, underlying issues of abandonment and rejection.

Though the two personality disorders share some common relational traits, they are considered by the DSM to be distinct disorders with their own set of diagnostic criteria.

Borderline personality traits

Over the years, various traits have been associated with borderline personality disorder, including:

1. Frantic efforts to avoid abandonment
2. Intense/unstable relationships with extremes of idealisation & denigration
3. Identity disturbance with a profoundly unstable sense of self (Kernberg’s Identity Diffusion)
4. Impulsive self-damaging behaviours
5. Recurrent suicidal behaviour or threats or self-injuring behaviour
6. Emotional instability marked by intense periods of irritability or anxiety
7. Chronic feelings of emptiness (related to sense of Rejection, Abandonment & Betrayal)
8. Frequent displays of inappropriate anger or rage
9. Transient, stress-related paranoid experience, delusions or severe dissociative symptoms

(Source: Jack Nathan, Confer Talk)

The most recent edition of the DSM (DSM 5, 2011) categorises individuals as suffering from borderline disorder only if they display these behaviours over time and if they cause a significant impairment in social functioning (e.g., work and relationships).

As the above list suggests, the borderline personality is characterised by noticeably unstable behaviours.

Relationships with others tend to be intense and marked by conflict, arguments and frequent breakups, with the individual often caught in a dynamic of pulling others in and pushing them away. As Mizen notes, “Borderlines are driven by that dynamic” (Link to Talk), a dynamic that has been popularly summed up as ‘I hate you, don’t leave me’ (the title of a best-selling book in the 1980s that first brought the concept of ‘borderline’ into the mainstream). This formulation captures the elements of rage, abandonment, dependency, and vulnerability, that characterise this personality structure. As Steiner notes, the term ‘borderline’ “does not only refer to a category of patients but also to a particular aspect of the mental structure of these patients and the location of the self in that structure” (Steiner, 1993).

The characteristic manifestations of rage, impulsivity, and destructive self-harming are typically related to and rooted in a desperate attempt to temporarily free the personality from an unbearable sense of inner shame, emptiness, or early sense of abandonment. These feelings of emptiness and shame are often masked and defended against in both borderline and narcissistic personalities, but can emerge suddenly and unpredictably when the underlying ‘wound’ to the self is exposed.

Narcissistic personality traits

Whereas individuals with borderline traits are diagnostically characterised by impulsive and compulsive behaviours (such as excessive spending, binge eating, self-harm, and risky sexual behaviours), those with narcissistic personality traits have been recognised as exhibiting an inflated sense of self-importance or grandiosity, and often take advantage of others to get their needs met. Over the years, various traits have been associated with borderline personality disorder, including:

1. Grandiose sense of self-importance
2. Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people
4. Requires excessive admiration
5. Has a sense of entitlement, and unreasonable expectations of especially favourable treatment
6. Is interpersonally exploitative
7. Lacks empathy
8. Is often envious of others or believes that others are envious of him/her
9. Displays arrogant, haughty behaviours or attitudes

(Souce, Phil Mollon Talk on Narcissistic Vulnerability and Shame)

The most recent edition of the DSM (DSM 5, 2011) categorises individuals as suffering from narcissistic disorder only if they display these behaviours over time and if they cause a significant impairment in social functioning (e.g., work and relationships). Narcissists are also likely to have problems with self-direction and closeness. Many narcissists are also substance misusers.

Individuals with this personality type may believe that they are special and therefore entitled to special treatment, require constant admiration and attention from others, and often exaggerate their achievements and fantasise about being powerful, attractive, or successful. Significantly lacking in empathy or awareness of the concerns or desires of those around them, they may take advantage of other people and show little interest in other people’s feelings or needs. Being preoccupied with self-image, the narcissistic personality is also often unempathic and envious towards others. It is this dynamic – an excessive need to inflate their sense of self, coupled with a concomitant need to deflate, denigrate, or dismiss others – that make this such an isolating and disruptive personality type.

Shame and grandiosity

Shame is commonly seen as “the core dread in narcissistic disturbance” (Mollon), a deep and pervasive feeling of being inadequate or unworthy. This may be due to early relational disruption, with the parent not attending to the infant in a responsive, nurturing way (see the ‘Blank Face’ experiments that Mollon describes, which suggest the bewildering distress that can be generated by the mother blanking her expression towards the three-month old infant; Mollon, Talk (video). This objectifying (‘I-It’) and dismissive form of attention may generate an enduring sense of not being worthy in the individual – not being worthy enough even to be looked at, perhaps thereby generating mechanisms of ‘self-mirroring’ in which the individual subsequently gets trapped inside (Mollon).

Because of its centrality in the aetiology of narcissistic disturbance, shame has therefore been called ‘the narcissistic affect’ (see Link to Talk), a catastrophic recognition of one’s essential inadequacy. The intense difficulty of revealing or ‘showing’ this wound to others can make therapeutic treatment very difficult: exposure of our narcissism also evokes shame. What is being ‘exposed to view’ here is a ‘shameful’ reminder of our deep dependency on others, hence our vulnerability – evoking this relational dependency can be a powerful reminder of how this can be misused or abused by others around us.

The characteristic formation of a ‘grandiose’ sense of self may thus be a ‘protective’ defence mechanism against an underlying and unbearable sense of humiliation and worthlessness – the ‘narcissistic wound’ that is such a feature of this type of personality, and a key focus of the analytic literature on it. Unmodified narcissism may manifest in clients variously as issues of shame (“shame-based clients”), anxiety, or an embarrassed, uncertain sense of self, or ‘false self’.

Thick-skinned and thin-skinned narcissism

The vulnerability and injury that lies at the heart of all forms of narcissism typically manifests as an acute sensitivity to insults, slights, or rejection. This sense of inner vulnerability may result in either a shy or withdrawn sense of self (so-called ‘thin-skinned’ form of narcissism) or a more grandiose or false sense of self (‘thick-skinned’ narcissism). Both forms serve to protect the vulnerable core. The key differences between these two types of narcissism has been summed up by Holmes:

THICK (or ‘overt’ narcissism): is unaware of impact on others; oblivious, tends to be male, thinks only of himself
THIN (or ‘covert’ narcissism): more commonly female, fragile, but parasitic

Holmes compellingly relates these two related forms to the figures of Narcissus and Echo in the original Greek myth, with Narcissus as the more obvious, well-known aspect (interestingly, it is this form of narcissism that seems to get the headlines and grab our attention), and the poor ‘thin-skinned’ nymph Echo, whose well-being and existence is utterly dependent on being admired by the other, on whom she is totally focussed. If the other disappears, she collapses: Echo has no voice of her own. Rosenfeld also distinguishes between thin-skinned narcissism (he notes its extreme sensitivity, and how it often manifests as issues of rejection or abandonment), and the thick-skinned form (characterised by entitlement, grandiosity, and arrogance). It is important to note that both forms present grandiosity and vulnerability; and both are self-absorbed (Pincus et al, 2009; see also Ronningstam & Guderson, 1991). As Mucci observes, the thin-skinned or ‘soft-skinned’ type is also similar in some ways to the ‘hyper-vigilant’ type as defined by Gabbard (low self-esteem, rejection sensitivity, diminished energy and vitality): an inhibited, shy, self-effacing self who avoids being the centre of attention (but whose self-devaluation exists side by side with a subtle form of superiority and entitlement: see Broucek, 1991).

Levels of severity: from ‘healthy’ to ‘malign’ narcissism

There has been extensive discussion concerning the different forms and levels of severity of narcissism, with some postulating a ‘healthy narcissism’ as essential to normal development, as distinct from the ‘malign’ or ‘pathological’ forms of narcissism (see Controversies). It is a fascinating but problematic area, tending to divide analysts into those who see narcissistic traits as essentially a compensation and defence for early relational rejection or disruption (Symington, Abse & Riddell, Lasch, Jung etc), and others who see it as something we are born with (Freud, Kohut, etc).

In its ‘malign’ or pathological form, individuals with narcissistic traits tend to have a problematic and frustrating relationship with social reality, which constantly threatens to undermine or expose the ‘grandiosity’ that the narcissistic self requires to maintain its identity. In this sense, as Mollon succinctly notes, “narcissism hates reality”: “Reality impinges on the illusory nirvana of experiencing no need, feeling only pleasure, and being the omnipotent centre of one’s world.” But, as with the issue of ‘healthy’ narcissism, the question of ‘reality’ is rather more problematic and complex than at first sight may appear, since reality is always a culturally and historically mediated construct, and all personality ‘disorders’ are defined against what is considered a social or cultural ‘norm’. In some cultures narcissistic traits may be more tolerated and even cultivated than in others, as Christopher Lasch’s best-selling book On Narcissism(1973), drew popular attention to (see also ‘Controversies‘).

Relational aspects

As Abse and Riddell suggest, narcissistic traits do not exist in isolation and can perhaps best be understood in terms of their relational aspects and dynamics. Pathological narcissism can be very damaging to other people, especially those who find themselves in an adult relationship with individuals with strong narcissistic traits, and we can be deeply wounded by the self-enclosed narcissism of other people. Similarly, individuals with narcissism might themselves have been deeply wounded in their early maturational development, through abusive, overstimulating, or erratic parenting (see ‘Aetiology‘).

Mollon notes that in our narcissistic state “we hate others”, as they impinge on our narcissism, our ‘centre-of-the-world’-ness. Relationships with other human beings also acutely but unconsciously remind the narcissistic self of its early (catastrophic) dependency and reliance on another, so that this aspect of the self may become cut off and disavowed: “The despised, needy, imperfect, defeated self is also hated”. This hatred of the whole concept of “dependency”, and the shame it evokes, can have profound political as well as personal implications.

As Nathan observes, narcissism generates an “intolerance of the receptive dependency on good objects”, leading to what Freud termed “the repudiation of femininity” (Freud, 1937c). Steiner also suggests how the deep embarrassment of (having feelings of) dependency can be quickly followed by “envious attack”: an envy-embarrassment axis, in which any issues to do with being small, dependent, and grateful – or indeed of being genuinely ‘good’, or improving/ progressing – can be ruthlessly torn down and attacked – as being despicable (Steiner, 1993). This again may make therapeutic treatment extremely difficult, since the very idea of ‘therapy’ suggests ideas of improvement and indeed dependency.

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