Violence in patients with narcissistic personality pathology: observations of a clinical series

This paper presents clinical observations on a group of nine patients whose action consisted of either the commission of violent acts or of seriously threatening behaviors suggestive of precursors to violence. A cluster of common features was observed to be present to some degree in all patients: (1) significant narcissistic personality pathology, (2) recent narcissistic injury, (3) inability to acknowledge or express affect related to this injury, (4) some history of impulsiveness when stressed, and (5) the availability of a weapon. Discussion is presented that the clinician's ability to predict the potential for violence may be enhanced by special attention to these features.