Narcissistic rage: The Achilles’ heel of the patient with chronic physical illness

Figures & data

Figure 1 Dying Achilles at Achilleion, Corfu. Sculptor: Ernst Herter, 1884.

Table 1 Patients’ demographic profile and disease parameters (N = 878)

Demographics
Age [median, mean ± SD]	56, 53.7 ± 15.9
Education
Primary school	459 (52.3%)
High school	254 (28.9%)
College/University	165 (18.8%)
Gender
Female	499 (56.8%)
Male	379 (43.1%)
Disease duration
<1 year (short-term disease)	196 (22.6%)
>1 year (long-term disease)	670 (77.4%)
Mean disease duration (years) in patients with long-term disease	9.8 ± 8.3
Diagnosis (N)
Colorectal cancer	162
Rheumatoid arthritis	168
Systemic lupus erythematosus	56
Systemic sclerosis	56
Sjögren’s syndrome	40
Multiple sclerosis	79
Inflammatory bowel disease	218
Glaucoma	100

Table 2 Correlation of “narcissistic rage” with psychosocial variables studied in patients with short-term and long-term physical illness

Outcome variables	Patients with disease duration <1 year (N = 196)	Patients with disease duration >1 year (N = 670)
Interpersonal difficulties (IIP)	0.245*	0.350***
Depressive symptoms (SCL-90)	0.213*	0.307***
Anxiety symptoms (SCL-90)	0.073	0.285***
Somatization symptoms (SCL-90)	0.054	0.203***
Psychotic symptoms (SCL-90)	0.153	0.345***
Physical symptoms of depression (GHQ)	−0.074	−0.133**
Depressive symptoms associated with social relationships (GHQ)	−0.040	−0.133**
General health (WHOQOL-BREF)	0.058	−0.219***
Physical HRQOL (WHOQOL-BREF)	0.079	−0.152***
Mental HRQOL (WHOQOL-BREF)	0.103	−0.236***
Social relationships HRQOL (WHOQOL-BREF)	0.149	−0.227***
Environment HRQOL (WHOQOL-BREF)	0.118	−0.188***

Notes: Pearson correlation coefficients,

* p < 0.05,

** p < 0.01,

*** p < 0.001.

Abbreviation: HRQOL, health-related quality of life.

Table 3 Scores in all outcome variables among medical patients with low and high rates on “narcissistic rage” (NR) according to their disease duration (analysis of covariance adjusted for age, gender, and educational level)

Psychosocial variables	Disease Duration	Low NR	High NR	F	p
		Mean ± SE	Mean ± SE
Interpersonal problems (IIP mean)	< 1 year	0.58 ± 0.06	0.79 ± 0.05	6.6	0.011
	> 1 year	0.73 ± 0.04	1.18 ± 0.04	54.8	<0.0005
Depression symptoms(SCL-90)	< 1 year	0.75 ± 0.06	0.89 ± 0.06	2.8	0.093
	> 1 year	0.81 ± 0.04	1.20 ± 0.04	37.8	<0.0005
Anxiety symptoms (SCL-90)	< 1 year	0.40 ± 0.06	0.55 ± 0.05	3.3	0.069
	> 1 year	0.53 ± 0.05	0.95 ± 0.05	37.1	<0.0005
Somatization symptoms (SCL-90)	< 1 year	0.75 ± 0.07	0.79 ± 0.07	0.2	0.642
	> 1 year	0.95 ± 0.05	1.23 ± 0.05	19.2	<0.0005
Paranoid ideation symptoms (SCL-90)	< 1 year	0.57 ± 0.08	1.00 ± 0.07	15.6	<0.0005
	> 1 year	0.73 ± 0.05	1.42 ± 0.05	95.3	<0.0005
Psychoticism symptoms (SCL-90)	< 1 year	0.33 ± 0.04	0.43 ± 0.43	2.8	0.096
	> 1 year	0.36 ± 0.03	0.67 ± 0.03	45.9	<0.0005
Physical symptoms of depression (GHQ-28)	< 1 year	12.8 ± 0.44	12.4 ± 0.04	0.5	0.487
	> 1 year	12.5 ± 0.29	13.7 ± 0.26	9.6	0.002
Depressive symptoms associated with social relationships (GHQ-28)	< 1 year	15.2 ± 0.37	14.6 ± 0.36	1.1	0.289
	> 1 year	14.3 ± 0.22	15.1 ± 0.22	4.9	0.027
General health (WHOQOL-BREF)	< 1 year	66.2 ± 2.5	68.2 ± 2.2	0.3	0.569
	> 1 year	66.3 ± 1.5	58.5 ± 1.6	11.9	0.001
Physical HRQOL (WHOQOL-BREF)	< 1 year	57.1 ± 2.3	60.7 ± 2.2	1.3	0.260
	> 1 year	62.7 ± 1.3	56.7 ± 1.3	10.0	0.002
Mental HRQOL (WHOQOL-BREF)	< 1 year	63.9 ± 2.3	67.0 ± 2.1	0.9	0.340
	> 1 year	65.3 ± 1.1	56.3 ± 1.1	30.5	<0.0005
Social relationships HRQOL (WHOQOL-BREF)	< 1 year	61.3 ± 2.8	66.7 ± 2.5	2.0	0.157
	> 1 year	62.3 ± 1.5	53.7 ± 1.5	15.3	<0.0005
Environment HRQOL (WHOQOL-BREF)	< 1 year	63.1 ± 2.3	64.7 ± 2.3	0.3	0.596
	> 1 year	60.1 ± 1.0	55.9 ± 1.0	8.3	0.004

Notes: The number of cases with “low narcissistic rage” was 76 for patients with disease duration less than one year and 233 for patients with disease duration more than one year. The respective numbers of cases with “high narcissistic rage were 82 and 237.

Abbreviation: HRQOL, health-related quality of life.

Table 4 Hierarchical models of the factors associated with difficulties in interpersonal relationships (IIP-40 mean) in medical patients with disease duration less than one year (A) and more than one year (B)

Variables	Model 1	Model 2	Model 3
A. Disease duration less than one year
Demographics
Age	0.023	0.010	0.005
Gender	−0.164	−0.160	−0.028
Education	−0.164	−0.148	−0.143
“Narcissistic rage”	–	0.230*	0.106
Psychological distress (SCL-90 GSI)	–	–	0.404***
Adjusted R^2	0.029	0.073	0.201
Incremental adjusted R^2	0.029	0.044	0.128
Significance of F change	0.116	0.018	<0.0005
B. Disease duration more than one year
Demographics
Age	0.073	0.079	0.068
Gender	−0.086	−0.159	−0.037
Education	−0.039	−0.118	−0.106
“Narcissistic rage”	–	0.391***	0.183***
Psychological distress (SCL-90 GSI)	–	–	0.668***
Adjusted R^2	0.001	0.135	0.489
Incremental adjusted R^2	0.001	0.134	0.354
Significance of F change	0.622	<0.0005	<0.0005

Notes: Independent variables were sequentially entered in linear regression models in which the dependent variable was the IIP-40 mean score. Values shown are standardized (beta) regression coefficients;

* p < 0.05;

** p < 0.01;

*** p < 0.001.