The Case of Edward Thad: An Ethical Dilemma
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Professionals – including physicians – who are suspected of ethical violations may be referred or brought for psychiatric evaluation. Unethical behaviors are associated with several psychiatric diagnoses including narcissistic personality disorder (NPD) which may occur in medical students and residents. The consequences are often significant with implications for the safety of these trainee-patients as well as colleagues and patients. Individuals with NPD may be high functioning and appear superficially competent. The maladaptive consequences of their personality emerge most strikingly in response to narcissistic injury, a criticism, or disappointment that exposes the vulnerability inherent in their sense of self. Such intrapsychic defeats are relatively common during the process of medical training. The resulting behavior is frequently intense rage or alternatively timid withdrawal. Psychotherapy offers potential benefits but is often challenging due to poor patient engagement. Clinicians treating trainees with suspected NPD should be alert to the possibility of antisocial traits which may be incompatible with ideals of the profession of medicine. Team-based care is advised, and collaboration with the trainee’s supervisors may be indicated.
KeywordsMedical ethics violation Personality disorder Narcissistic personality disorder Antisocial personality disorder Professional misconduct Schema-focused psychotherapy Transference-focused psychotherapy
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