Pathological Narcissism: A Study of Burden on Partners and Family

Clinician Diagnostic Ratings and Countertransference Reactions Towards Grandiose and Vulnerable Narcissism

BACKGROUND

Narcissistic personality disorder (NPD) is known to comprise two distinct but connected phenotypes related to 'grandiosity' and 'vulnerability', respectively. While evidence suggests differing countertransference responses to narcissism subtype expression, no study has examined this using a qualitative methodology and explored associations with ratings of personality disorder severity.

METHOD

Mental health clinicians (N = 180, 67% female, age = 38.9), completed qualitative clinical reflections and ratings of overall personality disorder severity towards two hypothetical vignettes displaying pathological narcissism ('grandiose' and 'vulnerable' narcissism respectively), as well as a rating of attitudes towards patients in their routine practice who resemble these vignettes.

RESULTS

Distinct qualitative themes were identified between narcissistic subtype, with grandiose narcissism evoking anger, lack of empathy and hopelessness, compared to sympathy, sadness and discomfort in vulnerable narcissism. In terms of diagnostic category, the grandiose vignette was predominately identified as 'narcissistic personality disorder' (97%), whereas the vulnerable vignette was a mixture of 'depressive disorder' (29%), 'narcissistic personality disorder' (24%), 'trauma and stressor related disorders' (21%) and 'borderline personality disorder' (21%). Attitude scores differed significantly between subtypes, with more negative attitudes towards narcissistic grandiosity than narcissistic vulnerability. The grandiose vignette was also rated as displaying more overall personality impairment, with an association observed between negative clinician attitude scores and increased ratings of personality disorder severity.

DISCUSSION

Two potential pathways are outlined to interpret these findings. The first is that inordinate stigma towards narcissistic grandiosity negatively biases clinicians when working with these patients due to feelings of anger and frustration. The second is that clinicians are drawn to minimise pathology of vulnerable patients due to their feelings of sadness and empathy. We propose that effective diagnosis and psychotherapy for pathological narcissism rely on clinicians' ability to balance these two dilemmas and resist either extreme.

Emotional Dependence and Narcissism in Couple Relationships: Echo and Narcissus Syndrome

Emotional dependency consists of an extreme affective need that manifests pathologically, such that it has been established that the partners of emotionally dependent individuals exhibit narcissistic traits. The present study aimed to examine the relationship between emotional dependency, the narcissistic traits of a romantic partner, and psychological abuse, in addition to examining the sex differences in the first two variables. This study included 271 subjects (144 women and 127 men) between the ages of 18 and 66 (M = 36.9; SD = 14.748). This study compared individuals with and without emotional dependency, finding that those with emotional dependency reported more narcissistic partners. Furthermore, psychological abuse was positively correlated with the narcissism of the partner. There were no significant sex differences in emotional dependency or in the exhibition of narcissistic traits. The importance of examining the connections between emotional dependency, the narcissistic traits of a romantic partner, and the potential for psychological abuse within these relationships are highlighted.

Adverse childhood experiences leading to narcissistic personality disorder: a case report

BACKGROUND

Narcissistic personality disorder (NPD) is associated with a complex interplay of genetic, neurobiological, and environmental factors. In this case report, we discuss the association between adverse childhood experiences (ACEs) and the development of NPD in adulthood.

CASE PRESENTATION

Here, we report a clinical case of NPD to illustrate how ACEs, particularly physical and emotional neglect, combined with early life parental overvaluation, can impair emotional regulation and self-worth, contributing to the development of narcissistic traits. We analyse, in light of existing literature, how ACEs are associated with a wide spectrum of personality disorders, how parental overvaluation is linked to grandiose narcissism, and how childhood neglect and abuse are associated with vulnerable narcissism.

CONCLUSION

ACEs are the primary risk factor for the development of NPD in adulthood. Dysfunctional household environments and parenting practices compound the association between ACEs and pathological narcissism. It is important to address childhood trauma for the prevention and treatment of NPD. Further research is necessary to clarify how individual factors influence the relationship between ACEs and pathological narcissism.

Psychopathic Traits and Parental Practices in Greek-Cypriot Community and Dutch Clinical Referred Samples

Parental practices are associated with psychopathic traits across several developmental stages. However, the majority of available studies focused mainly on the affective dimension of psychopathy, namely callous-unemotional traits, disregarding the grandiose-deceitful and impulsivity-need for stimulation dimensions. The current study examines the distinct associations between all three dimensions with parental practices (parental involvement, poor monitoring, inconsistent discipline, and corporal punishment) after considering the effect of conduct problems (CPs) and sex in a Greek-Cypriot primary school sample (N = 792, Mage = 6.93, SD = 0.72) and a Dutch clinical-referred sample (N = 217, Mage = 9.55, SD = 1.79) of children. In the community sample, hierarchical multiple regression analysis revealed that parents of children with high levels of callous-unemotional traits were more likely to engage in inconsistent discipline but less in positive parental practices. In contrast, high levels of impulsivity-need for stimulation were related to inconsistent discipline. In the clinical sample, callous-unemotional traits were associated with less parental involvement and grandiose-deceitful dimension with high levels of inconsistent discipline. These findings suggest that the three psychopathy dimensions have unique relations with parental practices above and beyond CPs, proposing that parental practices may be influenced more strongly by psychopathic traits than by antisocial behavior.

Validation of the pathological narcissistic inventory (PNI) and its brief form (B-PNI) in the Arabic language

BACKGROUND

The Pathological Narcissism Inventory (PNI) is a multidimensional measure developed to assess narcissistic grandiosity and narcissistic vulnerability. We aimed to validate the Arabic version of the original Pathological Narcissistic Inventory (PNI) and its brief form (B-PNI) in a community sample of Lebanese adults.

METHODS

The English language PNI items were translated into Arabic following a rigorous translation, back-translation, and linguistic evaluation. A total of 401 participants were administered the translated PNI, as well as previously validated Arabic versions of the Big Five Inventory-2, the Rosenberg Self-esteem Scale, the Patient Health Questionnaire (PHQ-9), and the Impulsivity-8 Scale.

RESULTS

Exploratory and confirmatory analyses supported the existence of seven first-order and two second-order factors of the PNI and B-PNI. Except for exploitativeness where females scored lower than males, no other significant differences by gender were observed for the remaining PNI subscale scores. Additionally, scores on all the subscales exhibited good reliability, while the associations with external measures supported the concurrent validity of the translated instrument.

CONCLUSION

The results of this study suggest that scores on the PNI and B-PNI are highly reliable with satisfactory concurrent and factorial validity, providing an assessment of broadly defined pathological narcissism among the Lebanese young adult population. The availability of the Arabic PNI and its brief form should facilitate improved understanding of pathological narcissism in Arabic cultures and the different factors that govern narcissistic personality pathology.

"It's not you, it's me": identity disturbance as the main contributor to interpersonal problems in pathological narcissism

BACKGROUND

Core impairments in self and other functioning typify individuals with personality disorder. While interpersonal dysfunction is a known element of narcissistic disorders, empirical research investigating intrapersonal elements is lacking. The aim of this study was to investigate the internal representations of individuals with grandiose and vulnerable features, as manifested through their attachment styles, and the specific role of identity disturbance in explaining the relationship between pathological narcissism and maladaptive interpersonal functioning.

METHODS

A sample of 270 university students completed the Brief Pathological Narcissism Inventory (B-PNI), the Severity Indices of Personality Problems (SIPP), the Relationship Questionnaire (RQ), and the Inventory of Interpersonal Problems (IIP-32).

RESULTS

Both vulnerable and grandiose narcissism were positively associated with both fearful and preoccupied attachment, and negatively associated with secure attachment, whilst grandiose narcissism was also positively associated with dismissive attachment. Furthermore, unstable representations of self, poor self-reflective functioning, and low sense of purpose fully mediated the relationship between interpersonal problems and grandiose narcissism while partially mediating the relationship between interpersonal problems and vulnerable narcissism.

CONCLUSIONS

Overall, our findings suggest that for individuals presenting with narcissistic features, capacity for adaptive interpersonal functioning is grounded by deficits in identity integration. Implications of these findings are discussed.

Narcissistic traits in young people and how experiencing shame relates to current attachment challenges

BACKGROUND

Young people with pathological narcissistic traits may have more maladaptive ways of relating to themselves and others. In this study, we investigated how the experience of shame may be a mechanism by which vulnerable and grandiose pathological narcissism relates to negative and positive internalised models of the self and others, manifested as attachment styles.

METHODS

Participants (N = 348) were young people who reported on pathological narcissism, the experience of shame and their model of self and others (secure, dismissive, preoccupied and fearful attachment). Mediation of the experience of shame between vulnerable and grandiose narcissism on the one hand and secure, dismissive, preoccupied and fearful attachment on the other hand, was tested using a path model.

RESULTS

Shame mediated the relationship between vulnerable narcissism and a more negative model of others and self (i.e. less secure, more fearful and more preoccupied in attachment). Higher grandiose narcissism traits were related to a more positive model of others and self (i.e. more secure attachment) and were unrelated to the experience of shame.

CONCLUSIONS

Young people with vulnerable narcissism traits tended to report more shame, and struggled to be close to others. It may be that shame experiences highlight a discrepancy between the ideal and actual self that may contribute to a more insecure attachment style. A good working alliance and fostering self-compassion may counter some negative effects of shame in those most vulnerable, but dismissal in those most grandiose presents a clinical conundrum requiring further research.

Living with pathological narcissism: a qualitative study

Background

Research into the personality trait of narcissism have advanced further understanding of the pathological concomitants of grandiosity, vulnerability and interpersonal antagonism. Recent research has established some of the interpersonal impacts on others from being in a close relationship with someone having such traits of pathological narcissism, but no qualitative studies exist. Individuals with pathological narcissism express many of their difficulties of identity and emotion regulation within the context of significant interpersonal relationships thus studying these impacts on others is warranted.

Method

We asked the relatives of people high in narcissistic traits (indexed by scoring above a cut-off on a narcissism screening measure) to describe their relationships (N = 436; current romantic partners [56.2%]; former romantic partners [19.7%]; family members [21.3%]). Participants were asked to describe their relative and their interactions with them. Verbatim responses were thematically analysed.

Results

Participants described 'grandiosity' in their relative: requiring admiration, showing arrogance, entitlement, envy, exploitativeness, grandiose fantasy, lack empathy, self-importance and interpersonal charm. Participants also described 'vulnerability' of the relative: contingent self-esteem, hypersensitivity and insecurity, affective instability, emptiness, rage, devaluation, hiding the self and victimhood. These grandiose and vulnerable characteristics were commonly reported together (69% of respondents). Participants also described perfectionistic (anankastic), vengeful (antisocial) and suspicious (paranoid) features. Instances of relatives childhood trauma, excessive religiosity and substance abuse were also described.

Conclusions

These findings lend support to the importance of assessing the whole dimension of the narcissistic personality, as well as associated personality patterns. On the findings reported here, the vulnerable aspect of pathological narcissism impacts others in an insidious way given the core deficits of feelings of emptiness and affective instability. These findings have clinical implications for diagnosis and treatment in that the initial spectrum of complaints may be misdiagnosed unless the complete picture is understood. Living with a person with pathological narcissism can be marked by experiencing a person who shows large fluctuations in affect, oscillating attitudes and contradictory needs.

Narcissistic traits in young people: understanding the role of parenting and maltreatment

BACKGROUND

Elevated narcissism in young people often sets up a cascade of interpersonal and mental health challenges, reinforcing the need to understand its concomitants. Experiences of maltreatment and different parenting styles have been implicated but findings to date are inconclusive. By simultaneously considering multiple remembered parenting styles and maltreatment in a large sample, this study aims to elucidate possible prognostic factors associated with both grandiose and vulnerable narcissistic traits in youth.

METHODS

Young people (N = 328, age range: 17-25 years) reported on the remembered interpersonal environment and current grandiose and vulnerable narcissism traits. Structural equation modelling was used to examine maternal and paternal parenting styles and examine the association between experiences of parenting and grandiose and vulnerable narcissism.

RESULTS

Remembered overprotection from mothers and fathers was associated with both vulnerable and grandiose narcissistic traits. Remembered maternal overvaluation related to current grandiosity, and maternal leniency related to vulnerable narcissistic traits. For paternal parenting, the combination of overvaluation and leniency and overvaluation and care explained grandiose and vulnerable traits. There was no direct effect of remembered parental care or childhood maltreatment on current levels of narcissistic traits.

CONCLUSIONS

Remembered childhood experiences of being overprotected, overvalued and experiencing leniency in parental discipline, were associated with higher traits of pathological narcissism in young people. Care and maltreatment were non-specific risk factors. Remembered childhood environments of being excessively pampered are associated with grandiose and vulnerable narcissistic traits, characterised by the young person expressing unrealistic self-views, entitlement beliefs and impaired autonomy. In treatment these traits may emerge in the patient-therapist relationship and working through their developmental origins may contribute to outcomes.