Pathological narcissism and sudden suicide-related collapse

Psychiatric inpatient admission of three nondepressed young men who escaped deadly self-injury provided an opportunity to study their character organization. Defects in affect-regulatory functions and evidences of pathological narcissism were identified and explored. Each patient had a specific suicide-risk consultation and a psychotherapy evaluation. Each denied intent to kill himself, and none acknowledged experience of depression or the wish to die. Each also denied his suicidal behavior involved significant risks, and each discounted the importance of obvious, identifiable stressors as triggers for it. The interrelation between pathological narcissism and this particular suicidal behavior is discussed. These observations can assist in the assessment of suicide risk in nondepressed patients.