Personality-driven depression: The case for malignant self-regard (and depressive personalities).

Many patients with chronic depression are not well-treated. In part, this is due to the underlying personality dynamics that maintain the depressive experience are ignored. In this paper, I describe the concept of malignant self-regard, a derivative of the depressive personality. I describe briefly its origins in the clinical and empirical literature and focus upon the presentation of a case of a patient who displays a prototypic manifestation of malignant self-regard. I offer some ideas for how to manage such patients, with a focus on countertransference experiences that can be used to inform treatment.