Self-Regulatory Dysfunctions in Personality Disorders: The Role of Poor Self-Monitoring and Mindreading

Feeling but not caring: empathic alteration in narcissistic men with high psychopathic traits

Psychopathy is a personality disorder characterized by specific interpersonal-affective deficits and social deviance often marked by reduced empathy and decreased affective response to the suffering of others. However, recent findings in community samples suggest that the somatosensory resonance to other's pain measured with electroencephalography (EEG) is increased by psychopathic traits. This study aimed at comparing both the response to physical pain and the observation of pain being inflicted to another person in individuals with clinically significant psychopathic traits, namely patients with severe narcissistic personality disorder (NPD, n=11), and community controls (CC, n=13). The gating of somatosensory responses to a tactile steady-state stimulation (25 Hz) during the observation of pain-evoking and non-painful visual stimuli of hands was measured using EEG. Pain thresholds were assessed with a quantitative sensory testing (QST) battery. NPD compared with CC subjects showed similar thermal pain thresholds, but significantly higher pain pressure thresholds (PPT). Significantly greater somatosensory gating (SG) during the anticipation and the observation of pain in others was observed in NPD compared with CC subjects, but this difference was not associated with differences in self-pain perception. SG to pain observation was positively correlated with the Impulsivity-Egocentricity (IE) dimension of psychopathy. These findings demonstrated a stronger somatosensory resonance in the high psychopathic trait NPD group that suggests an increased somatic representation of observed pain despite lower dispositional empathy.

The associations between pathological narcissism, alexithymia and disordered eating attitudes among participants of pro-anorexic online communities

PURPOSE

This study investigated the relationships between pathological narcissism, alexithymia, and disordered eating attitudes among participants of pro-anorexic online communities. Specifically, we explored the possible moderating role of alexithymia in the relationships between narcissistic vulnerability and disordered eating attitudes.

METHODS

Participants included 97 Israeli female young adults who are active participants in pro-anorexic online communities. These participants completed a battery of self-reported questionnaires: The Pathological Narcissism Inventory (PNI); The Eating Attitudes Test-26 (EAT-26); and The Toronto Alexithymia Scale (TAS-20).

RESULTS

Narcissistic grandiosity, vulnerability, and alexithymia were positively related to disordered eating attitudes. Alexithymia moderated the relationships between narcissistic vulnerability and the total score of disordered eating attitudes. Furthermore, alexithymia moderated the relationships between both narcissistic vulnerability and grandiosity and the oral control subscale of EAT-26.

CONCLUSIONS

These findings highlight the interaction between the pathological narcissism and the fundamental trait of alexithymia that might put individuals at risk for disordered eating.

A neural model of mechanisms of empathy deficits in narcissism

From a multidimensional perspective, empathy is a process that includes affective sharing and imagining and understanding the emotions of others. The primary brain structures involved in mediating the components of empathy are the anterior insula (AI), the anterior cingulate cortex (ACC), and specific regions of the medial prefrontal cortex (MPFC). The AI and ACC are the main nodes in the salience network (SN), which selects and coordinates the information flow from the intero- and exteroreceptors. AI might play a role as a crucial hub – a dynamic switch between 2 separate networks of cognitive processing: the central executive network (CEN), which is concerned with effective task execution, and the default mode network (DMN), which is involved with self-reflective processes. Given various classifications, a deficit in empathy may be considered a central dysfunctional trait in narcissism. A recent fMRI study suggests that deficit in empathy is due to a dysfunction in the right AI. Based on the acquired data, we propose a theoretical model of imbalanced SN functioning in narcissism in which the dysfunctional AI hub is responsible for constant DMN activation, which, in turn, centers one’s attention on the self. This might hinder the ability to affectively share and understand the emotions of others. This review paper on neural mechanisms of empathy deficits in narcissism aims to inspire and direct future research in this area.

The narcissistic self and its psychological and neural correlates: an exploratory fMRI study

BACKGROUND

The concept of narcissism has been much researched in psychoanalysis and especially in self psychology. One of the hallmarks of narcissism is altered emotion, including decreased affective resonance (e.g. empathy) with others, the neural underpinnings of which remain unclear. The aim of our exploratory study was to investigate the psychological and neural correlates of empathy in two groups of healthy subjects with high and low narcissistic personality trait. We hypothesized that high narcissistic subjects would show a differential activity pattern in regions such as the anterior insula that are typically associated with empathy.

METHOD

A sample of 34 non-clinical subjects was divided into high (n=11) and low (n=11) narcissistic groups according to the 66th and 33rd percentiles of their scores on the Narcissism Inventory (NI). Combining the psychological, behavioral and neuronal [i.e. functional magnetic resonance imaging (fMRI)] measurements of empathy, we compared the high and low narcissistic groups of subjects.

RESULTS

High narcissistic subjects showed higher scores on the Symptom Checklist-90 - Revised (SCL-90-R) and the 20-item Toronto Alexithymia Scale (TAS-20) when compared to low narcissistic subjects. High narcissistic subjects also showed significantly decreased deactivation during empathy, especially in the right anterior insula.

CONCLUSIONS

Psychological and neuroimaging data indicate respectively higher degrees of alexithymia and lower deactivation during empathy in the insula in high narcissistic subjects. Taken together, our preliminary findings demonstrate, for the first time, psychological and neuronal correlates of narcissism in non-clinical subjects. This might stipulate both novel psychodynamic conceptualization and future psychological-neuronal investigation of narcissism.

Metacognition in schizophrenia: associations with multiple assessments of executive function

Deficits in metacognitive capacity, or the abilities to think about thinking, are thought to be a key barrier to functioning in schizophrenia. Although metacognitive function may be linked to executive function, it is unclear how the different domains of each phenomenon are related to one another. Accordingly, we assessed 4 domains of metacognition on the basis of a self-generated narrative using the Metacognition Assessment Scale. These were correlated with subtests of the Delis Kaplan Executive Function System which assessed 2 domains of executive function: mental flexibility and inhibition. Participants were 49 men with schizophrenia spectrum disorders in a postacute phase of illness. Spearman Rho correlations revealed awareness of one's thoughts and feelings were more closely linked to performance on tests which required mental flexibility while recognizing others' needs, and independent relationships were more closely linked to performance on tasks which required inhibitory control. Results suggest different domains of metacognition may be influenced by and influence different neurocognitive processes.