Pathological narcissism (PN) and narcissistic personality disorder (NPD) have primarily been identified by striking external features, such as superiority, attention seeking and a critical or condescending attitude, and less attention has been paid to the internal processing contributing to this particular personality functioning. High dropout from treatment and challenges in building a therapeutic alliance with these patients call for further understanding of the complexity of disordered narcissism. Recent research on neuropsychological underpinnings to narcissistic pathology have provided valuable information that can inform therapeutic interventions for patients with this personality pathology. Internal processing in patients with PN or NPD is specifically influenced by compromised emotion processing and tolerance, identity diffusion, fluctuating sense of agency, reflective ability, perfectionism-related self- esteem, and ability to symbolize. The aim of this article is to review research studies with relevance for internal processing related to disordered narcissism and integrate findings with therapeutic strategies in alliance building with these patients.

中文翻译：

---

病理性自恋或自恋型人格障碍患者的内部处理：对联盟建设和治疗策略的影响

病理性自恋 (PN) 和自恋型人格障碍 (NPD) 主要通过显着的外部特征来识别，例如优越感、寻求关注以及批评或居高临下的态度，而很少关注有助于这种特殊人格功能的内部处理. 治疗的高辍学率和与这些患者建立治疗联盟的挑战要求进一步了解无序自恋的复杂性。最近关于自恋病理学的神经心理学基础的研究提供了有价值的信息，可以为患有这种人格病理学的患者提供治疗干预。PN 或 NPD 患者的内部加工特别受到情绪加工和耐受性受损、身份扩散、波动的代理感、反思能力、完美主义相关的自尊和象征能力。本文的目的是回顾与无序自恋相关的内部处理相关的研究，并将研究结果与与这些患者建立联盟的治疗策略相结合。