Characterological depression in patients with narcissistic personality disorder

Abstract

Background: Depressive symptoms often occur in patients with personality disorders. Along the lines of the precious concepts of reactive and melancholic forms of depression, two different patterns of depressive symptoms can be identified. Reactive forms of depression is considered to be related to dysfunction of emotional regulation and social functioning, and to personality disorders. This study aimed at exploring the pattern of depressive symptoms in patients with Narcissistic Personality Disorder (NPD) compared to a group of depressed patients without Personality Disorder (PD). The Newcastle Diagnostic Depression Scale (NDDS) is a clinical instrument designed to differentiate reactive depression from melancholic depression.

Method: The study investigated patterns of depressive symptoms in 117 out-patients, divided into two groups. One group containing 56 patients with depressive symptoms by no PD and the other group comprised of 61 patients with depressive symptoms and NPD. The participants were interviewed using the Newcastle Diagnostic Depression Scale.

Results: There was a significant difference between the groups, as the NPD group suffered from reactive forms of depression. The NPD group showed a pattern of depressive symptoms characterized by fluctuation of the depressive state, without time demarcation of depressive episode, ruminations preoccupied with hostility and accusatory feelings towards other, but not self-accusatory feelings, fluctuation suicidal ideation triggered by external events accompanied by parasuicidal behavior, lack of neuro-vegetative symptoms such as insomnia with early wakening, loss of appetite and weight loss. The No PD group showed the opposite pattern.

Conclusion: Based on these results NDDS is considered to be an applicable instrument for identifying personality pathology in patients with depressive symptoms, by recognizing the specific pattern. This is thought to be important for adequate treatment planning.

Keywords:

• Narcissism
• narcissistic personality disorder
• depression
• depressive symptoms
• characterological depression
• reactive depression
• melancholic depression
• non-melancholic depression

Disclosure statement

The authors do not have any commercial association that might pose a conflict of interest in connection with the study.Jane Fjermestad-Noll, Erik Simonsen and Bo Bach are employed at the Psychiatric Research Unit Region Zealand Denmark, Bent Rosenbaum is a professor at the University of Copenhaggen and Elsa Ronningstam is employed t MacLean Hospitl, MA, USA, and associate professor at Harvard medical School.

Additional information

Funding

The study was partially made possible by funding granted to the first author from the Health Scientific Research Fund of Region Zealand.