| Abstract |
Background: The theoretical background of this dissertation is composed of contemporary
psychoanalytic theories which analyze the dynamic processes involved in narcissism,
addiction and the inter-relationships of such intrapsychic phenomena. More specifically, Self
Psychology’s conceptualizations of narcissism as a distinct developmental line and addiction
as a self/ narcissistic disorder helps in integrating broader psychoanalytic thinking regarding
the relationship of the two phenomena in a clinically useful way. Previous research has
connected Narcissistic Personality Disorder to addiction using DSM defined phenomenology
and assessing the prevalence and commorbidity of the disorder. There is a gap in the
research literature when it comes to the application of broad and clinically useful
understandings derived from psychoanalytic thinking, particularly Self Psychology, in
studying pathological narcissism.
Aim: The aims of the present dissertation are to confirm the hypothesis that substance
dependent individuals are characterized by narcissistic disturbances, to offer an inclusive
structural description of their personality profile, and to highlight the predominant themes in
their self experience.
Method: This dissertation includes three studies employing different, yet complementary
methods. In the first study, we test for differences between substance dependent and non
dependent individuals regarding individual dimensions of pathological narcissism
(vulnerability, grandiosity) with the Pathological Narcissism Inventory. In the second study,
we present analytic descriptive data for the substance dependent group with the Rorschach
Inkblot Test and, based on these findings, we follow an interpretative personality profile
analysis. In the third study, we thematically analyze the interview protocols of people confronting the challenges of substance abuse treatment and rehabilitation focusing on their
self experiences.
Findings: Comparisons of substance dependent individuals to non substance dependent
participants yielded significantly higher scores in the narcissistic vulnerability subscale of the
Pathological Narcissism Inventory. The structural personality assessment suggested adequate
adjustment and stress control, some thought disturbance better attributed to emotional
difficulties and personality style, unstable and conflicted self-perception and self-esteem,
difficulties in affect self-regulation, some healthy aspects in their interpersonal relations with
concomitant significant problems in dependency and mirroring needs, and preoccupation
with aggressiveness. The predominant themes in self experience include: concealment of the
vulnerable and shame-ridden self and the significance of one’s image; the defective sense of
self and the pressing need for acceptance; detachment and a mechanistic use of others in
place of relatedness; and difficulties with affect self-regulation and containing aggression.
Conclusions: All three studies highlighted the significant narcissistic disturbances that
substance dependent individuals experience. Moreover, these difficulties are more likely to
be related to vulnerability than to grandiosity, which appears to comprise a defensive attempt
involving the substance. Integrating findings from different methods and theoretical
perspectives and expanding clinical assessment beyond the mere use of diagnostic criteria
offers a better understanding of the processes involved in clinical phenomena such as
narcissism and this, in turn, has far-reaching implications for therapeutic planning and
intervening.
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