We review the literature on pathological narcissism and narcissistic personality disorder (NPD) and describe a significant criterion problem related to four inconsistencies in phenotypic descriptions ...and taxonomic models across clinical theory, research, and practice; psychiatric diagnosis; and social/personality psychology. This impedes scientific synthesis, weakens narcissism's nomological net, and contributes to a discrepancy between low prevalence rates of NPD and higher rates of practitioner-diagnosed pathological narcissism, along with an enormous clinical literature on narcissistic disturbances. Criterion issues must be resolved, including clarification of the nature of normal and pathological narcissism, incorporation of the two broad phenotypic themes of narcissistic grandiosity and narcissistic vulnerability into revised diagnostic criteria and assessment instruments, elimination of references to overt and covert narcissism that reify these modes of expression as distinct narcissistic types, and determination of the appropriate structure for pathological narcissism. Implications for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the science of personality disorders are presented.
Differing perspectives on the operationalization of schizotypal personality pathology (STPP) have led to numerous multidimensional assessment measures. The current study applied the interpersonal ...construct validation approach to self-report data from 856 undergraduate students to formally examine the interpersonal content, similarities, and differences in the subscales of four measures of STPP within and across two interpersonal circumplex surfaces using a bootstrapping methodology for computing confidence intervals around circumplex structural summary method parameters. Results suggested that negative-like expressions of STPP are prototypically and distinctively interpersonal constructs associated with cold and socially avoidant interpersonal problems and hypersensitivity to others’ warmth and affection. Positive-like expressions of STPP as assessed by two out of four measures were prototypically and distinctively interpersonal constructs associated with vindictiveness. Across four measures, there was notable overlap in interpersonal correlates among related subscales, suggesting convergent validity. However, subscales containing social anxiety content were associated with more submissive (i.e., socially avoidant) interpersonal problems than subscales without social anxiety content.
This review documents two themes of emphasis found in phenotypic descriptions of pathological narcissism across clinical theory, social/personality psychology, and psychiatric diagnosis. Clinical ...theories of narcissism spanning 35 years consistently describe variations in the expression of pathological narcissism that emphasize either grandiosity or vulnerable affects and self-states. Recent research in social/personality psychology examining the structure of narcissistic personality traits consistently finds two broad factors representing Grandiosity–Exhibitionism and Vulnerability–Sensitivity–Depletion respectively. However, the majority of psychiatric criteria for narcissistic personality disorder (NPD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) emphasize expressions of grandiosity. By placing most of the diagnostic emphasis on overt grandiosity, DSM NPD has been limited by poor discriminant validity, modest levels of temporal stability, and the lowest prevalence rate on Axis II. Despite converging support for two phenotypic themes associated with pathological narcissism, psychiatric diagnosis and social/personality psychology research often focus only on grandiosity in the assessment of narcissism. In contrast, clinical theory struggles with a proliferation of labels describing these broad phenotypic variations. We conclude that the construct of pathological narcissism is at a crossroads and provide recommendations for diagnostic assessment, clinical conceptualization, and future research that could lead to a more integrated understanding of narcissistic personality and narcissistic personality pathology.
Personality disorders (PDs) are among the most common and severe classes of psychopathology. From a clinical perspective, it is challenging to help individuals with personality disorders because ...treatment ruptures, discontinuation, reversals, and failures are relatively common. An additional clinical challenge is that the model used to diagnose personality disorders is demonstrably incorrect. Recent efforts to improve diagnosis of personality disorders apply two criteria: the first distinguishes personality disorders from other kinds of psychopathology and the second distinguishes different types of personality disorders. However, this approach has been problematic in that, as currently operationalized, it does not provide a clear demarcation for personality disorders, and it uses a framework for individual differences that is more apt as a model of variation in psychopathology in general. This article proposes that the core of personality disorders involves difficulties understanding and relating to self and others, and thus the personality disorders should be recast as the interpersonal disorders. Interpersonal dysfunction explains extreme social challenges and treatment difficulties that are characteristic of this class of psychopathology. This approach provides a clearer model for distinguishing these kinds of problems, as demonstrated by reformulating traditional personality disorder symptoms from an interpersonal perspective.
Public Significance Statement
Personality disorders are among the most common and severe classes of psychopathology. Research and intervention development for personality disorders is held back by an invalid diagnostic system. Replacing the personality disorders with the interpersonal disorders would provide a more valid, ethical, useful, and clinically compelling model.
Life span developmental theories suggest that as individuals age, they accumulate knowledge about how to deploy emotion regulation (ER) strategies effectively and learn how to match their ER strategy ...use with changes in situational demands. Using an event-contingent experience sampling design wherein 150 adults Age 18 to 89 years reported on 64,213 social interactions (M = 427.41, SD = 145.66) during 9 weeks of daily life, this study examines (a) age-related differences in individuals' usual ER strategy use (reappraisal, suppression) during everyday social interactions, (b) age-related differences in how much individuals' use of these two strategies varies across social situations-ER variability, and (c) age-related differences in the extent to which ER strategy use covaries with relational (close vs. nonclose others) and emotional (happy, sad) contextual features of those social situations-ER flexibility. In line with a small body of prior work, usual ER strategy use did not differ across adulthood and ER variability was lower at older ages. Results from multilevel models of intraindividual covariation suggested that individuals flexibly matched their ER strategy implementation to changes in emotional context-especially when interacting with close others. The results also provided evidence that the intraindividual covariation between relational context and use of suppression was weaker at older ages. Beyond these specific findings, this study demonstrated the utility of experience sampling designs, event-contingent reports, and the measurement/modeling of intraindividual variation and covariation for study of emotional development across the life span.
Physical activity is considered a valuable tool for enhancing life satisfaction. However, the processes linking these constructs likely differ across the adult life span. In older adults the ...association between physical activity and life satisfaction appears to involve usual levels of physical activity (i.e., a between-person association driven by differences between more and less active people). In younger adults the association has consistently been based on day-to-day physical activity (i.e., a within-person association driven by differences between more and less active days). To resolve this inconsistency, a daily diary study was conducted with a life span sample of community-dwelling adults (age 18-89 years; N = 150) over three 21-day measurement bursts. Usual physical activity was positively associated with life satisfaction in middle and older adulthood; however, this association was not present in young adulthood. When present, this between-person association was mediated by physical and mental health. A within-person association between physical activity and life satisfaction was also present (and did not differ across age). Generally, on days when people were more physically active then was typical for them, they experienced greater life satisfaction. Age differences in life satisfaction followed a cubic trajectory: lower during emerging adulthood, higher during midlife, and lower during older adulthood. This study adds to accumulating evidence that daily fluctuations in physical activity have important implications for well-being regardless of age, and clarifies developmental differences in life satisfaction dynamics that can inform strategies for enhancing life satisfaction.
The construct of narcissism is inconsistently defined across clinical theory, social-personality psychology, and psychiatric diagnosis. Two problems were identified that impede integration of ...research and clinical findings regarding narcissistic personality pathology: (a) ambiguity regarding the assessment of pathological narcissism vs. normal narcissism and (b) insufficient scope of existing narcissism measures. Four studies are presented documenting the initial derivation and validation of the Pathological Narcissism Inventory (PNI). The PNI is a 52-item self-report measure assessing 7 dimensions of pathological narcissism spanning problems with narcissistic grandiosity (Entitlement Rage, Exploitativeness, Grandiose Fantasy, Self-sacrificing Self-enhancement) and narcissistic vulnerability (Contingent Self-esteem, Hiding the Self, Devaluing). The PNI structure was validated via confirmatory factor analysis. The PNI correlated negatively with self-esteem and empathy, and positively with shame, interpersonal distress, aggression, and borderline personality organization. Grandiose PNI scales were associated with vindictive, domineering, intrusive, and overly-nurturant interpersonal problems, and vulnerable PNI scales were associated with cold, socially avoidant, and exploitable interpersonal problems. In a small clinical sample, PNI scales exhibited significant associations with parasuicidal behavior, suicide attempts, homicidal ideation, and several aspects of psychotherapy utilization.
This study extended previous theory and cross-sectional research on narcissism-depression associations by taking a prospective longitudinal approach to examining how pathological narcissism relates ...to the severity, within-person variability, within-person instability, and change in depressive symptoms among a sample of 235 undergraduate students assessed weekly for 8 weeks. Findings revealed that, at baseline, pathological narcissism was concurrently positively associated with multiple measures of depressive symptoms (e.g., general depression, anhedonic loss of interest, anhedonic lack of positive affect) and distinctively predicted the severity of anhedonic loss of interest over time. Pathological narcissism assessed at baseline also predicted higher variability and instability in both general depression and loss of interest (but not lack of positive affect), and related to less change in loss of interest over 8 weeks. The results of the present study are discussed in the context of existing research on narcissism-depression relations and suggestions for future research are provided.
This article briefly summarizes the empirical and clinical literature underlying a contemporary clinical model of pathological narcissism. Unlike the DSM Narcissistic Personality Disorder (NPD), this ...clinical model identifies and differentiates between two phenotypic themes of dysfunction-narcissistic grandiosity and narcissistic vulnerability-that can be expressed both overtly and covertly in patients' ways of thinking, feeling, behaving, and participating in treatment. Clinical recognition that narcissistic patients can and often do present for psychotherapy in vulnerable states of depression, anxiety, shame, and even suicidality increases the likelihood of accurate diagnosis and effective treatment planning. This article provides case examples derived from psychotherapies with narcissistic patients to demonstrate how narcissistic grandiosity and narcissistic vulnerability concurrently present in patients who seek treatment.
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