{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T17:31:25Z","timestamp":1788888685076,"version":"build-2803163510"},"reference-count":80,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T00:00:00Z","timestamp":1632700800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"This research received funds from Research Grants to support PDM-oriented research by The Scientific Committee of the Psychodynamic Diagnostic Manual, 2nd Edition (PDM-2) and the Interdisciplinary Council on Developmental and Learning Disorders.","award":["1"],"award-info":[{"award-number":["1"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Depressive disorders in adolescence are among the most challenging clinical syndromes to diagnostically identify and treat in psychotherapy. The Psychodynamic Diagnostic Manual, Second Edition (PDM-2) proposes an integration between nomothetic knowledge and an idiographic understanding of adolescent patients suffering from depression to promote a person-centered approach. This single-case study was aimed at describing and discussing the clinical value of an accurate diagnostic assessment within the PDM-2 framework. Method: Albert, a 16-year-old adolescent with a DSM-5 diagnosis of major depressive disorder, was assessed using instruments from various perspectives: the Structured Clinical Interview for DSM-5; the Psychodynamic Chart-Adolescent of the PDM-2, and other clinician-report instruments; and the Shedler\u2013Westen Assessment Procedure for Adolescents and Defense Mechanisms Rating Scale Q-sort, coded by external observers. Results: Albert\u2019s assessment revealed impairments in various mental capacities, especially in regulating self-esteem. He presented a borderline personality organization at a high level and an emerging narcissistic personality syndrome. Conclusions: The case discussion showed the importance of providing clinically meaningful assessments to plan for effective treatments in youth populations. Especially, it is necessary to understand the adolescent\u2019s unique characteristics in terms of mental and personality functioning and consider the developmental trajectories and adaptation processes that characterize this specific developmental period.<\/jats:p>","DOI":"10.3390\/ijerph181910127","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T04:55:33Z","timestamp":1632718533000},"page":"10127","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["From a Symptom-Based to a Person-Centered Approach in Treating Depressive Disorders in Adolescence: A Clinical Case Formulation Using the Psychodynamic Diagnostic Manual (PDM-2)\u2019s Framework"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6098-2304","authenticated-orcid":false,"given":"Annalisa","family":"Tanzilli","sequence":"first","affiliation":[{"name":"Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, \u201cSapienza\u201d University of Rome, Via degli Apuli 1, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1620-5521","authenticated-orcid":false,"given":"Guido","family":"Giovanardi","sequence":"additional","affiliation":[{"name":"Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, \u201cSapienza\u201d University of Rome, Via degli Apuli 1, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora","family":"Patriarca","sequence":"additional","affiliation":[{"name":"Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, \u201cSapienza\u201d University of Rome, Via degli Apuli 1, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1298-3935","authenticated-orcid":false,"given":"Vittorio","family":"Lingiardi","sequence":"additional","affiliation":[{"name":"Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, \u201cSapienza\u201d University of Rome, Via degli Apuli 1, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, \u201cSapienza\u201d University of Rome, Via degli Apuli 1, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1097\/chi.0b013e318145ae1c","article-title":"Practice parameter for the assessment and treatment of children and adolescents with depressive disorders","volume":"46","author":"Birmaher","year":"2007","journal-title":"J. Am. Acad. Child. Adolesc. Psychiatry"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.jpeds.2019.12.003","article-title":"The burden of depression in adolescents and the importance of early recognition","volume":"218","author":"Petito","year":"2020","journal-title":"J. Pediatrics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1016\/S0140-6736(11)60871-4","article-title":"Depression in adolescence","volume":"379","author":"Thapar","year":"2012","journal-title":"Lancet"},{"key":"ref_4","unstructured":"World Health Organization (2017). Depression and Other Common Mental Disorders: Global Health Estimates, World Health Organization."},{"key":"ref_5","unstructured":"(2013, September 30). National Collaborating Centre for Mental Health. Available online: https:\/\/www.nice.org.uk\/guidance\/qs48."},{"key":"ref_6","unstructured":"National Collaborating Centre for Mental Health (2005). Depression in Children and Young People: Identification and Management in Primary, Community and Secondary Care, British Psychological Society."},{"key":"ref_7","unstructured":"American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, DSM IV\u2013R, American Psychiatric Publishing."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Publishing. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_9","unstructured":"(2021, May 01). World Health Organization. Available online: https:\/\/icd.who.int\/browse11\/l-m\/en."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Hilt, R., and Nussbaum, A. (2016). DSM-5 Pocket Guide for Child and Adolescent Mental Health, American Psychiatric Association Publishing.","DOI":"10.1176\/appi.books.9781615370511"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Achterbergh, L., Pitman, A., Birken, M., Pearce, E., Sno, H., and Johnson, S. (2020). The experience of loneliness among young people with depression: A qualitative meta\u2013synthesis of the literature. BMC Psychiatry, 20.","DOI":"10.1186\/s12888-020-02818-3"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.adolescence.2015.08.007","article-title":"Beyond a diagnosis: The experience of depression among clinically\u2013referred adolescents","volume":"44","author":"Midgley","year":"2015","journal-title":"J. Adolesc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/j.pedhc.2006.02.010","article-title":"Adolescent depression: A metasynthesis","volume":"20","author":"Dundon","year":"2006","journal-title":"J. Pediatric Health Care"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Hall, G.S. (1904). Adolescence: Its Psychology and Its Relation to Physiology, Anthropology, Sociology, Sex, Crime, Religion and Education, Appleton & Company.","DOI":"10.1037\/10616-000"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1001\/jama.281.18.1707","article-title":"Depressed adolescents grown up","volume":"281","author":"Weissman","year":"1999","journal-title":"JAMA"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/S2352-4642(19)30059-8","article-title":"Identifying depression early in adolescence","volume":"3","author":"Kieling","year":"2019","journal-title":"Lancet Child. Adolesc. Health"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Lingiardi, V., and McWilliams, N. (2017). Psychodynamic Diagnostic Manual: (PDM\u20132), Guilford Press. [2nd ed.].","DOI":"10.4324\/9780429447129-11"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1037\/pap0000207","article-title":"Psychotherapy research and the Psychodynamic Diagnostic Manual (PDM\u20132)","volume":"35","author":"Hilsenroth","year":"2018","journal-title":"Psychoanal. Psychol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1037\/pap0000194","article-title":"Reclaiming the developmental lens for adolescent formulation and diagnosis: Application of the PDM\u20132 to clinical cases","volume":"35","author":"Malone","year":"2018","journal-title":"Psychoanal. Psychol."},{"key":"ref_20","unstructured":"Krueger, R.F., and Tackett, J.L. (2006). Back to the future: Personality structure as a context for psychopathology. Personality and Psychopathology, Guilford Press."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1037\/pap0000308","article-title":"A bridge between person\u2013based versus symptom\u2013based nosology: A clinical case study using the Psychodiagnostic Chart\u20132","volume":"38","author":"Patriarca","year":"2021","journal-title":"Psychoanal. Psychol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1521\/pedi.2011.25.6.842","article-title":"Prevalence and comorbidity of Axis I and Axis II disorders among treatment refractory adolescents admitted for specialized psychotherapy","volume":"25","author":"Feenstra","year":"2011","journal-title":"J. Pers. Disord."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jad.2013.08.023","article-title":"Comorbidity of personality disorders in mood disorders: A meta\u2013analytic review of 122 studies from 1988 to 2010","volume":"152\u2013154","author":"Friborg","year":"2014","journal-title":"J. Affect. Disord."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.jaac.2013.12.030","article-title":"An empirically derived classification of adolescent personality disorders","volume":"53","author":"Westen","year":"2014","journal-title":"J. Am. Acad. Child. Adolesc. Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1037\/0022-006X.75.5.716","article-title":"Empirically derived subtypes of adolescent depression: Latent profile analysis of co-occurring symptoms in the Treatment for Adolescents with Depression Study (TADS)","volume":"75","author":"Herman","year":"2007","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.jad.2013.09.008","article-title":"Refining a complex diagnostic construct: Subtyping dysthymia with the Shedler-Westen Assessment Procedure-II","volume":"152\u2013154","author":"Huprich","year":"2014","journal-title":"J. Affect. Disord."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1176\/appi.ajp.2008.07030376","article-title":"Refining the construct of narcissistic personality disorder: Diagnostic criteria and subtypes","volume":"165","author":"Russ","year":"2008","journal-title":"Am. J. Psychiatry"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Blatt, S.J. (2008). Polarities of Experience: Relatedness and Self-Definition in Personality Development, Psychopathology, and the Therapeutic Process, American Psychological Association.","DOI":"10.1037\/11749-000"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1037\/pst0000193","article-title":"Psychotherapy relationships that work III","volume":"55","author":"Norcross","year":"2018","journal-title":"Psychotherapy"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1177\/000306516501300102","article-title":"Notes on countertransference","volume":"13","author":"Kernberg","year":"1965","journal-title":"J. Am. Psychoanal. Assoc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1080\/00107530.2015.1137177","article-title":"Relational turn and psychotherapy research","volume":"52","author":"Lingiardi","year":"2016","journal-title":"Contemp. Psychoanal."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1176\/appi.ajp.162.5.890","article-title":"Countertransference phenomena and personality pathology in clinical practice: An empirical investigation","volume":"162","author":"Betan","year":"2005","journal-title":"Am. J. Psychiatry"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1037\/a0036410","article-title":"Long-term effects of analysis of the patient\u2013therapist relationship in the context of patients\u2019 personality pathology and therapists\u2019 parental feelings","volume":"82","author":"Dahl","year":"2014","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1037\/pst0000213","article-title":"Therapists\u2019 responses toward dependent (anaclitic) and self-critical (introjective) depressed outpatients: A multilevel approach","volume":"56","author":"Hennissen","year":"2019","journal-title":"Psychotherapy"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1002\/eat.20650","article-title":"Countertransference reactions to adolescents with eating disorders: Relationships to clinician and patient factors","volume":"42","author":"Satir","year":"2009","journal-title":"Int. J. Eat. Disord."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1037\/per0000260","article-title":"Patient SWAP-200 personality dimensions and FFM traits: Do they predict therapist responses?","volume":"9","author":"Tanzilli","year":"2018","journal-title":"Pers. Disord."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1080\/00223891.2019.1674318","article-title":"Clinician reactions when working with adolescent patients: The Therapist Response Questionnaire for Adolescents","volume":"102","author":"Tanzilli","year":"2020","journal-title":"J. Pers. Assess."},{"key":"ref_38","unstructured":"Lingiardi, V., and McWilliams, N. (2017). Psychodiagnostic Chart\u2013Adolescent (PDC\u2013A). Psychodynamic Diagnostic Manual:(PDM\u20132), Guilford Press. [2nd ed.]."},{"key":"ref_39","unstructured":"Westen, D. (2004). Clinical Diagnostic Interview, Emory University. unpublished manual."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1176\/appi.ajp.2010.09101489","article-title":"Agreement between clinician and patient ratings of adaptive functioning and developmental history","volume":"167","author":"DeFife","year":"2010","journal-title":"Am. J. Psychiatry"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1002\/jclp.22089","article-title":"Development of a Q-sort version of the Defense Mechanism Rating Scales (DMRS-Q) for clinical use","volume":"70","author":"Perry","year":"2014","journal-title":"J. Clin. Psychol."},{"key":"ref_42","unstructured":"Lingiardi, V., and McWilliams, N. (2017). Psychodiagnostic Chart\u20132 (PDC\u20132). Psychodynamic Diagnostic Manual: (PDM\u20132), Guilford Press. [2nd ed.]."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1037\/per0000146","article-title":"Factor structure, reliability, and validity of the Therapist Response Questionnaire","volume":"7","author":"Tanzilli","year":"2016","journal-title":"Pers. Disord."},{"key":"ref_44","unstructured":"Greenberg, L.S., and Pinsof, W.M. (1986). The development of the Working Alliance Inventory. The Psychotherapeutic Process: A Research Handbook, Guilford Press."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1037\/0022-0167.36.2.223","article-title":"Development and validation of the Working Alliance Inventory","volume":"36","author":"Horvath","year":"1989","journal-title":"J. Couns. Psychol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1037\/h0085885","article-title":"The generalizability of the psychoanalytic concept of the working alliance","volume":"16","author":"Bordin","year":"1979","journal-title":"Psychotherapy"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1176\/appi.ajp.2011.11020274","article-title":"An empirically derived taxonomy for personality diagnosis: Bridging science and practice in conceptualizing personality","volume":"169","author":"Westen","year":"2012","journal-title":"Am. J. Psychiatry"},{"key":"ref_48","first-page":"393","article-title":"Assessing adolescent personality disorders with the Shedler\u2013Westen Assessment Procedure for Adolescents","volume":"20","author":"DeFife","year":"2013","journal-title":"Clin. Psychol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1007\/s40618-017-0629-7","article-title":"Challenges in assessing personality of individuals with gender dysphoria with the SWAP-200","volume":"40","author":"Lingiardi","year":"2017","journal-title":"J. Endocrinol. Investig."},{"key":"ref_50","unstructured":"Shedler, J., Westen, D., and Lingiardi, V. (2014). The Evaluation of Personality with the SWAP-200, Raffaello Cortina Publisher."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1176\/ajp.2006.163.7.1285","article-title":"Clinical assessment of pathological personality traits","volume":"163","author":"Westen","year":"2006","journal-title":"Am. J. Psychiatry"},{"key":"ref_52","unstructured":"Perry, J.C. (1990). The Defense Mechanism Rating Scales Manual, Cambridge Hospital\u2014Harvard. [5th ed.]."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1080\/00332747.2019.1579595","article-title":"The role of defense mechanisms in emerging personality disorders in clinical adolescents","volume":"82","author":"Gennaro","year":"2019","journal-title":"Psychiatry"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1097\/NMD.0000000000001230","article-title":"Defense mechanisms, gender, and adaptiveness in emerging personality disorders in adolescent outpatients","volume":"208","author":"Perry","year":"2020","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_55","first-page":"531","article-title":"Mentalization, attachment, and defense mechanisms: A Psychodynamic Diagnostic Manual\u20132\u2013oriented empirical investigation","volume":"24","author":"Tanzilli","year":"2021","journal-title":"Res. Psychother."},{"key":"ref_56","unstructured":"Kernberg, O.F. (1984). Severe Personality Disorders: Psychotherapeutic Strategies, Yale University Press."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Caligor, E., Kernberg, O.F., Clarkin, J.F., and Yeomans, F.E. (2018). Psychodynamic Therapy for Personality Pathology: Treating Self and Interpersonal Functioning, American Psychiatric Association Publishing.","DOI":"10.1176\/appi.books.9781615373529"},{"key":"ref_58","unstructured":"Lingiardi, V., and McWilliams, N. (2017). Emerging personality patterns and syndromes in adolescence\u2014PA Axis. Psychodynamic Diagnostic Manual: (PDM\u20132), Guilford Press. [2nd ed.]."},{"key":"ref_59","unstructured":"Winnicott, D.W. (1960). Ego distortion in terms of true and false self. The Maturational Processes and the Facilitating Environment: Studies in the Theory of Emotional Development, Karnac Books."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Moselli, M., Casini, M.P., Frattini, C., and Williams, R. (2021). Suicidality and personality pathology in adolescence: A systematic review. Child. Psychiatry Hum. Dev., in press.","DOI":"10.1007\/s10578-021-01239-x"},{"key":"ref_61","unstructured":"Lingiardi, V., and McWilliams, N. (2017). Adolescent symptom patterns: The subjective experience\u2014SA Axis. Psychodynamic Diagnostic Manual: (PDM\u20132), Guilford Press. [2nd ed.]."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Blatt, S.J. (2004). Experiences of Depression: Theoretical, Clinical, and Research Perspectives, American Psychological Association.","DOI":"10.1037\/10749-000"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.comppsych.2016.07.006","article-title":"Reliability and clinical usefulness of the personality inventory for DSM\u20135 in clinically referred adolescents: A preliminary report in a sample of Italian inpatients","volume":"70","author":"Somma","year":"2016","journal-title":"Compr. Psychiatry"},{"key":"ref_64","first-page":"167","article-title":"Distinctive features of short-term psychodynamic-interpersonal psychotherapy: A review of the comparative psychotherapy process literature","volume":"7","author":"Blagys","year":"2000","journal-title":"Clin. Psychol."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Gabbard, G.O. (2009). Textbook of Psychotherapeutic Treatments, American Psychiatric Association Publishing.","DOI":"10.1176\/appi.books.9781585623648"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Cregeen, S., Hughes, C., Midgley, N., Rhode, M., and Rustin, M. (2017). Short-Term Psychoanalytic Psychotherapy for Adolescents with Depression: A Treatment Manual, Karnac Books.","DOI":"10.4324\/9780429480164"},{"key":"ref_67","unstructured":"McWilliams, N. (2011). Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process, Guilford Press. [2nd ed.]."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"598866","DOI":"10.3389\/fpsyt.2020.598866","article-title":"The study of motivation in the suicidal process: The motivational interview for suicidality","volume":"11","author":"Moselli","year":"2021","journal-title":"Front. Psychiatry"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1950","DOI":"10.3389\/fpsyg.2017.01950","article-title":"Anger as a basic emotion and its role in personality building and pathological growth: The neuroscientific, developmental and clinical perspectives","volume":"8","author":"Williams","year":"2017","journal-title":"Front. Psychol."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Williams, R., Casini, M.P., Moselli, M., Frattini, C., and Ronningstam, E. (2021). The road from pathological narcissism to suicidality in adolescence: An empirical study. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18189761"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"111","DOI":"10.3928\/00485713-20090301-09","article-title":"Narcissistic personality disorder: Facing DSM\u2013V","volume":"39","author":"Ronningstam","year":"2009","journal-title":"Psychiatr. Ann."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Van Schie, C.C., Jarman, H.L., Reis, S., and Grenyer, B. (2021). Narcissistic traits in young people and how experiencing shame relates to current attachment challenges. BMC Psychiatry, 21.","DOI":"10.1186\/s12888-021-03249-4"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Ogrodniczuk, J.S. (2013). Interpersonal problems of narcissistic patients. Understanding and Treating Pathological Narcissism, American Psychological Association.","DOI":"10.1037\/14041-000"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1037\/per0000061","article-title":"Empathy in narcissistic personality disorder: From clinical and empirical perspectives","volume":"5","author":"Krusemark","year":"2014","journal-title":"Personal Disord."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1037\/per0000065","article-title":"Attachment and mentalization in female patients with comorbid narcissistic and borderline personality disorder","volume":"5","author":"Diamond","year":"2014","journal-title":"Personal Disord."},{"key":"ref_76","unstructured":"Gabbard, G.O., and Crisp, H. (2018). Narcissism and Its Discontents: Diagnostic Dilemmas and Treatment Strategies with Narcissistic Patients, American Psychological Association."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1037\/pst0000111","article-title":"Countertransference when working with narcissistic personality disorder: An empirical investigation","volume":"54","author":"Tanzilli","year":"2017","journal-title":"Psychotherapy"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1521\/pedi.2020.34.supp.42","article-title":"Clinician emotional responses and therapeutic alliance when treating adolescent patients with narcissistic personality disorder subtypes: A clinically meaningful empirical investigation","volume":"34","author":"Tanzilli","year":"2020","journal-title":"J. Pers. Disord."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"129","DOI":"10.3928\/00485713-20090301-03","article-title":"Transference and countertransference: Developments in the treatment of narcissistic personality disorder","volume":"39","author":"Gabbard","year":"2009","journal-title":"Psychiatr. Ann."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1002\/jclp.21898","article-title":"Alliance building and narcissistic personality disorder","volume":"68","author":"Ronningstam","year":"2012","journal-title":"J. Clin. Psychol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/19\/10127\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:05:33Z","timestamp":1760166333000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/19\/10127"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,27]]},"references-count":80,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2021,10]]}},"alternative-id":["ijerph181910127"],"URL":"https:\/\/doi.org\/10.3390\/ijerph181910127","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,27]]}}}