UKRAINS'KYI VISNYK PSYKHONEVROLOHII

The Scientific and Practical Journal of Medicine
ISSN 2079-0325(p)
DOI 10.36927/2079-0325
Home » Archive of numbers » 2018 » Volume 26, issue 1 (94) » Narcissistic personality disorders and suicidal behavior. A psychodynamic perspective with treatment problems

Narcissistic personality disorders and suicidal behavior. A psychodynamic perspective with treatment problems

Authors

Type of Article

  • Scientific Article

In the Section

  • DIAGNOSTICS AND TREATMENT OF MENTAL AND DRUG ADDICTION DISORDERS

Key words

Index UDK:
  • 616.89-008.441.44-008.447-06-08

Abstract

Suicidal threats, gestures and overt attempts and suicide are common problems in patients with narcissistic and other severe personality disorders. From a psychodynamic perspective, suicidal behaviour is based on both aggression as well as narcissistic self-regulation. Challenges for the clinical treatment of patients with suicidal behaviour and narcissistic disorders are described and discussed from a psychodynamic perspective. Negative self-concept, the ambivalence of suicide and aggression in suicide attempters and other risk factors are discussed.

Psychotherapeutic treatment should follow a suicide attempt. The therapist or psychiatrist must gauge the intensity of the patient's suicidal ideation, the existence of plans, the availability of means, the depth of depression, the extent of social isolation, the amount of alcohol or drug intake, and the degree to which the patient's communications are trustworthy. Suicidal ideation in personality disordered patients has its primary source either in character pathology or affective illness, accordingly, apply a diff erent technical approaches. Besides the therapist's strong countertransference reactions typical problems pertaining to his/her attitude and psychotherapeutic process can occur. The focus of the therapy is on the suicidal trigger and the roots of the narcissism. Suicide or the threat of suicide are called on by the patients as solutions to long-standing intrapsychic confl icts. When the patient's aggression is stimulated by current anger, frustration or envy, self-destruction provides a means to cope with the internalised tormentor or destructive schema. Chronic suicidal behaviour of more severely disturbed narcissistic patients is related to particular treatment diffi culties and risks. Yet, it is precisely the time following a suicide attempt which offers an opportunity to understand patients' narcissistic dynamics and to process them more intensively. Suicidality often necessitates actionoriented interventions and departures from technical neutrality on the therapist's part.

Pages

  • 66-72

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References

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UKRAINS'KYI VISNYK PSYKHONEVROLOHII

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