Narcissistic personality disorder and emotion regulation in psychiatric inpatients

BackgroundEmotional regulation difficulties in those with narcissistic personality disorder can cause problematic social and occupational functioning and inhibit treatment. Identifying which aspects of emotion regulation difficulties narcissistic personality disorder (NPD) patients have can help inform treatment.Adult psychiatric inpatients (N = 108) were assessed on measures of emotion regulation. Propensity score matching (PSM) was utilized to match inpatients with a diagnosis of NPD (n = 54) to psychiatric peers on several criteria. An analysis of variance compared groups at admission and discharge. A moderation analysis was used to explore the effects of neuroticism across the treatment for NPD, and cut scores were used to explore the effect of neuroticism on NPD patients at admission and discharge.NPD patients demonstrated more difficulties with impulse control, engaging in goal-directed behaviours, clarity of emotions, emotional regulation strategies, and experiential avoidance at admission. NPD patients experienced difficulties with impulse control and acceptance of emotional responses at discharge. They were also more likely to end treatment before their peers. Neuroticism was a moderating factor in treatment of patients with NPD, with high neuroticism aligning with greater gains across treatment; however, high neuroticism NPD patients continued to report more difficulties with experiential avoidance and strategies for emotional regulation.LimitationsUse of self-report measures, reliance on DSM criteria for NPD diagnoses, and the generalizability to non-inpatient populations.ConclusionsNPD patients benefit from treatment but continue to struggle with aspects of emotion regulation. Addressing these aspects may help NPD patients receive more benefits from treatment.