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Abstract | 105 The narcissistic personality disorder presents, clinically, at three levels of severity. The mildest cases, who appear “neurotic,” usually present indications for psychoanalysis. They typically do consult only because of a signifi cant symptom, which seems so linked to their character pathology that anything but the treatment of their personality disorder would seem inadequate. In contrast, other narcissistic patients at that level present symptoms that may be treated without an effort to modify or resolve their narcissistic personality structure. All of these patients seem to be functioning in general, except they typically present with signifi cant problems in long-term intimate relationships and in long-term professional or work interactions. A second level of severity of illness of narcissistic personalities refl ects the typical syndrome with all the various clinical manifestations. These patients need treatment for their personality disorder, and here the alternative between standard psychoanalytic treatment and psychoanalytic psychotherapy depends on individualized indications and contraindications. A third level of severity of narcissistic personality disorder functions on an overt borderline level. In addition to all the typical manifestations of narcissistic personality disorder, the patient also presents general lack of anxiety tolerance, of impulse control, and a severe reduction in sublimatory functions (that is, in his capacity for productivity or creativity beyond gratifi cation of survival needs). These patients usually show severe and chronic failure in their work and profession, and chronic failure in their efforts to establish or maintain intimate relations. At this same level of severity, another group of patients may not show overt borderline features, but present signifi cant antisocial activity, which may place them in the same category as those who function on a borderline level. All of these severely narcissistic patients may respond to a psychoanalytic, transference-focused psychotherapy, unless, for individualized reasons, this approach would seem contraindicated, in which case a more supportive approach or cognitive behavioral approach might be the treatment of choice.1 Patients whose antisocial behavior is predominantly passive and parasitic present less of a threat to themselves and to the therapist than do those others who present severe suicidal and parasuicidal behavior, or violent attacks against others. Aggression against others or self is typical for antisocial behavior of the aggressive type, particularly when these patients fulfi ll the criteria for the syndrome of malignant narcissism. The syndrome of malignant narcissism includes, in addition to the narcissistic personality disorder, severe antisocial behavior, signifi cant paranoid trends, and self-directed or other-directed aggression. Let us review the dominant features of the narcissistic personality disorder as typically represented particularly at the second or intermediate level of severity.2 THIS ISSUE: Narcissistic Personality Disorders: Part 1

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@inproceedings{Kernberg2011GuestE, title={Guest Editorial @bullet @bullet Guest Editorial}, author={Otto F . Kernberg}, year={2011} }