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In reviewing descriptions of depressive and vulnerably narcissistic personalities, it might appear as if the same condition is being described. The authors briefly review the depressive and narcissistic personality constructs, highlighting the similarities in the two, but also identifying critical differences in how the conditions are manifested. By illustration of two case vignettes and identifying primary symptomatic distinctions, the authors describe the differences in conceptualizing and treating depressive symptoms in depressive and narcissistic personalities. Important distinctions in the roles of perfectionism and living up to idealized expectations are explained, as well as how to understand the role of what appears to be grandiosity. We conclude that while depressive symptoms develop similarly in narcissistic and depressive personalities, the critical distinctions between these organizations outlined in this paper call for divergent treatment approaches. Specially, treatment of depressive symptoms in depressive personalities should involve exploring the client’s disavowed needs and offering appropriate encouragement, while treating narcissistic personalities should focus on the integration of split-off object representations through, in part, challenging their grandiose strivings. Failure to disentangle narcissistic from depressive personalities can lead to counterproductive client internalizations and therefore splitting the categories as we suggest may lead to enhanced clinical utility.
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