Mentalization Based Treatment for Narcissistic Personality Disorder comorbid with Antisocial Personality Disorder
There has been increasing interest in antisocial and narcissistic personality disorder (NPD) over the past few years after decades of neglect. Narcissistic mechanisms are common in a range of personality disorders from avoidant to borderline (BPD) but are particularly pronounced in antisocial personality disorder (ASPD) and may be a factor interfering with good outcomes of treatment.
Personality functioning can be considered in terms of a propensity to lose mentalizing in interpersonal and social contexts, which in part is a result of hypersensitivity of the attachment system. But some patients deactivate the attachment system if possible and, as a result, distort their mentalizing process rather than lose it. So they may be abnormally good at certain aspects of mentalizing and as a consequence able to control their interpersonal interactions to satisfy their own wishes rather than engaging in ‘give and take’. The aim of mentalization based treatment is to increase or re-balance mentalizing capacities within social and interpersonal contexts.
FRCPsych Consultant to Anna Freud National Centre for Children and Families
Visiting Professor University College London
Affiliate Professor in Psychotherapy
Copenhagen University, Denmark
The aims of the workshop
MBT for personality disorder focuses on attachment processes and imbalances in mentalizing in terms of dimensions and modes. In this plenary session the attachment processes apparent during treatment of patients with ASPD/NPD will be outlined and a dimensional mentalizing profile discussed. Formulating narcissistic function in ASPD according to mentalizing dimensions and attachment strategies forms a rational basis for mentalizing interventions. These will be outlined and illustrated using clinical video.