Narcissism, Immature Defense Mechanisms Linked to Maladaptive Daydreaming, Study Shows

Individuals with a high degree of narcissism may be more likely to engage in excessive daydreaming that significantly affects their lives and daily function, according to a report in the Journal of Psychiatric Research and Clinical Practice. Those with narcissism who employ immature defensive reactions—such as denial, projection, and/or acting out—appear to be at the highest risk of maladaptive daydreaming.

Although not recognized in DSM, maladaptive daydreaming is a condition “characterized by an excessively immersive use of fantasy and imagination, involving detailed and vivid scenarios that significantly impact an individual’s daily life,” wrote Alessia Renzi, Ph.D., and Rachele Mariana, Ph.D., of Rome University. They added: “Preliminary findings from a population study estimate that approximately 2.5% of people experience clinical‐level impairment due to these immersive daydreams.”

A total of 562 individuals completed an online survey that included a demographic questionnaire and three measurement tools:

• The 16‐item Maladaptive Daydreaming Scale (MDS), in which participants rate their daydreaming experiences on a scale from zero (never/none of the time) to 100% (extremely frequent/all the time).
• The Defense Mechanism Rating Scales‐Self‐Report, which assesses 30 individual defense mechanisms categorized into mature, immature, and neurotic defenses.
• The Pathological Narcissism Inventory (PNI), which measures seven dimensions of narcissism (entitlement rage, exploitativeness, grandiose fantasy, self‐sacrificing self‐enhancement, contingent self‐esteem, hiding the self, and devaluing).

The researchers found that 29% of individuals reported an MDS score of 40 or higher, suggesting probable maladaptive daydreaming. There was a significant positive association between narcissism symptomatology and MDS scores—both for overall PNI score and scores on each of the seven narcissistic traits.

“Narcissism therefore both in its grandiose aspects and in its more intimate manifestations presents a close relationship with the controlled creation of daytime fantasies,” Renzi and Mariana wrote.

The link between narcissistic traits and MDS scores was mediated in part through the use of immature defenses, whereas mature defenses offered some protection against maladaptive daydreaming.

The researchers said that the results highlight “how possible treatments and clinical interventions that promote the use of mature defense mechanisms can help people, especially young adults, to cope with psychological distress caused by narcissistic fragility.” They added that “treatments with a psychodynamic orientation (such as defense‐based therapies, transference‐focus therapy or mentalizing‐based therapy) seem best suited to … reflecting on one’s defensive dynamics and promoting the use of mature ones.”

For related information, see the Psychiatric News Special Report “How to Work With Patients Using Problem-Focused Psychodynamic Psychotherapies.”

(Image: Getty Images/iStock/Orla)

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Narcissistic Traits May Predict Patients’ Response to CBT for Depression

The presence of narcissistic traits may predict how well a patient responds to cognitive-behavioral therapy (CBT) for depression, according to a study published in The Lancet Psychiatry.

“In the past decade of personality and personality disorder research, narcissism has emerged as a dimensional construct that is present both in individuals who are mentally healthy and in psychiatric clinical populations,” wrote Maike Richter, M.Sc., Simon Mota, Ph.D., of the University of Münster in Germany and colleagues. “Clinical practice shows that narcissistic traits below the threshold for narcissistic personality disorder are common, can lead to interpersonal problems, and might negatively affect psychiatric symptomatology, such as depression severity, treatment adherence, and outcome.”

Richter, Mota, and colleagues investigated the impact of narcissism on depressive symptoms before and after treatment in two large samples of adults aged 18 and older. One included both psychiatric inpatients and patients receiving outpatient psychotherapy at the University Hospital Münster who were treated with CBT. The second included inpatients treated with psychoanalytic interactional therapy (PIT) at the Asklepios Clinic, a psychiatric hospital in Tiefenbrunn, Germany. PIT is a psychodynamic treatment specially designed for patients with severe personality disorders. Before and after treatment, patients completed the Narcissistic Admiration and Rivalry Questionnaire-short version. The six-item measure evaluates two facets of grandiose narcissism: admiration (I am a very special person and this gives me a lot of strength) and rivalry (I desire my rivals to fail). The sum of all items on the questionnaire measured core narcissism.

CBT inpatient treatment included one 50-minute, one-on-one therapy session per week with a clinical psychologist or psychiatrist. Outpatient CBT treatments consisted of one 50-minute, one-on-one therapy session per week with a clinical psychologist trainee. Patients in the CBT group completed the Beck Depression Inventory-Revised, a 21-item questionnaire that measures depression severity. Patients in the PIT group received one or two 25-minute, one-on-one sessions per week with a clinical psychologist or psychiatrist. These patients self-reported depression symptoms by completing the Patient Health Questionnaire-9.

A total of 2,371 patients were included, with 1,569 in the CBT group and 802 in the PIT group. The mean treatment duration was 300 days in the CBT group and 67 days in the PIT group. Findings included the following:

• Core narcissism did not predict depression severity before treatment in either group.
• Narcissistic rivalry was associated with higher depressive symptoms at baseline, while narcissistic admiration was associated with lower depressive symptoms.
• In the CBT group, patients with core narcissism and narcissistic rivalry had poorer treatment responses, while narcissistic admiration showed no effect.
• In the outpatient CBT group, the therapeutic alliance mediated 31% of the total effect of narcissistic rivalry on depression severity after treatment.
• Narcissistic traits were not associated with the treatment outcome in the PIT group.

“In the end, perhaps it will not be treatment packages (CBT vs. psychodynamic therapy) that determine how best to treat patients with narcissistic traits and depression, but rather individual treatment components, wrote Jan Philipp Klein, Dr.Med., of the University of Lübeck and colleagues in an accompanying commentary. “Until further evidence is available, therapists should consider that in the treatment of patients with narcissistic traits, a particular emphasis on building a strong therapeutic alliance might improve outcomes.”

For related information, see the Psychiatric News articles “Narcissism and Its Discontents” and “Love Pathology in Narcissistic Patients Can Be Treated Effectively.”

(Image: iStock/NickyLloyd)

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Deadline Tomorrow: Submit Comments on Proposed Rules to Strengthen Parity Law

The Employee Benefit Security Administration, along with the Treasury Department and the Department of Health and Human Services, recently proposed new rules to strengthen the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) by closing loopholes and adding greater clarity to the law’s requirement. The deadline to submit comments on these proposed rules is tomorrow, October 17.

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