new research on narcissism

Narcissism Driven by Insecurity, Not Grandiose Sense of Self, New Psychology Research Shows

Narcissism is driven by insecurity, and not an inflated sense of self, finds a new study, which offers a more detailed understanding of this long-examined phenomenon and may also explain what motivates the self-focused nature of social media activity.

Narcissism is driven by insecurity, and not an inflated sense of self, finds a new study by a team of psychology researchers. Its research, which offers a more detailed understanding of this long-examined phenomenon, may also explain what motivates the self-focused nature of social media activity.

“For a long time, it was unclear why narcissists engage in unpleasant behaviors, such as self-congratulation, as it actually makes others think less of them,” explains Pascal Wallisch, a clinical associate professor in both New York University’s Department of Psychology and Center for Data Science and the senior author of the paper , which appears in the journal Personality and Individual Differences . “This has become quite prevalent in the age of social media—a behavior that’s been coined ‘flexing’.  

“Our work reveals that these narcissists are not grandiose, but rather insecure, and this is how they seem to cope with their insecurities.”

“More specifically, the results suggest that narcissism is better understood as a compensatory adaptation to overcome and cover up low self-worth,” adds Mary Kowalchyk, the paper’s lead author and an NYU graduate student at the time of the study. “Narcissists are insecure, and they cope with these insecurities by flexing. This makes others like them less in the long run, thus further aggravating their insecurities, which then leads to a vicious cycle of flexing behaviors.”

The survey’s nearly 300 participants—approximately 60 percent female and 40 percent male—had a median age of 20 and answered 151 questions via computer.

The researchers examined Narcissistic Personality Disorder (NPD), conceptualized as excessive self-love and consisting of two subtypes, known as grandiose and vulnerable narcissism. A related affliction, psychopathy, is also characterized by a grandiose sense of self. They sought to refine the understanding of how these conditions relate. 

To do so, they designed a novel measure, called PRISN ( P erformative R efinement to soothe I nsecurities about S ophisticatio N ), which produced FLEX (per F ormative se L f- E levation inde X ). FLEX captures insecurity-driven self-conceptualizations that are manifested as impression management, leading to self-elevating tendencies. 

The PRISN scale includes commonly used measures to investigate social desirability (“No matter who I am talking to I am a good listener”), self-esteem (“On the whole, I am satisfied with myself”), and psychopathy (“I tend to lack remorse”). FLEX was shown to be made up of four components: impression management (“I am likely to show off if I get the chance”), the need for social validation (“It matters that I am seen at important events''), self-elevation (“I have exquisite taste”), and social dominance (“I like knowing more than other people”). 

Overall, the results showed high correlations between FLEX and narcissism—but not with psychopathy. For example, the need for social validation (a FLEX metric) correlated with the reported tendency to engage in performative self-elevation (a characteristic of vulnerable narcissism). By contrast, measures of psychopathy, such as elevated levels of self-esteem, showed low correlation levels with vulnerable narcissism, implying a lack of insecurity. These findings suggest that genuine narcissists are insecure and are best described by the vulnerable narcissism subtype, whereas grandiose narcissism might be better understood as a manifestation of psychopathy.           

The paper’s other authors were Helena Palmieri, an NYU psychology doctoral student at the time of the study, and Elena Conte, an NYU psychology undergraduate student. 

DOI: 10.1016/j.paid.2021.110780

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September 1, 2023

14 min read

What Is Narcissism? Science Confronts a Widely Misunderstood Phenomenon

Researchers debate whether grandiosity always masks vulnerability

By Diana Kwon

Deena So’Oteh

C an you think of a narcissist? Some people might picture Donald Trump, perhaps, or Elon Musk, both of whom are often labeled as such on social media. Or maybe India's prime minister, Narendra Modi, who once wore a pinstripe suit with his own name woven in minute gold letters on each stripe over and over again.

But chances are you've encountered a narcissist, and they looked nothing like Trump, Musk or Modi. Up to 6 percent of the U.S. population, mostly men, is estimated to have had narcissistic personality disorder during some period of their lives. And the condition manifests in confoundingly different ways. People with narcissism “may be grandiose or self-loathing, extraverted or socially isolated, captains of industry or unable to maintain steady employment, model citizens or prone to antisocial activities,” according to a review paper on diagnosing the disorder.

Clinicians note several dimensions on which narcissists vary. They may function extremely well, with successful careers and vibrant social lives, or very poorly. They may (or may not) have other disorders, ranging from depression to sociopathy. And although most people are familiar with the “grandiose” version of narcissism—as displayed by an arrogant and pompous person who craves attention—the disorder also comes in a “vulnerable” or “covert” form, where individuals suffer from internal distress and fluctuations in self-esteem. What these seeming opposites have in common is an extreme preoccupation with themselves.

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Most psychologists who treat patients say that grandiosity and vulnerability coexist in the same individual, showing up in different situations. Among academic psychologists, however, many contend that these two traits do not always overlap. This debate has raged for decades without resolution, most likely because of a conundrum: vulnerability is almost always present in a therapist's office, but individuals high in grandiosity are unlikely to show up for treatment. Psychologist Mary Trump deduces, from family history and close observation, that her uncle, Donald Trump, meets the criteria for narcissistic as well as, probably, antisocial personality disorder, at the extreme end of which is sociopathy. But “coming up with an accurate and comprehensive diagnosis would require a full battery of psychological and neuropsychological tests that he'll never sit for,” she notes in her book on the former president.

Now brain science is contributing to a better understanding of narcissism. It's unlikely to resolve the debate, but preliminary studies are coming down on the side of the clinicians: vulnerability indeed seems to be the hidden underside of grandiosity.

Fantasy or Reality?

Tessa, a 25-year-old who now lives in California, has sometimes felt on top of the world. “I would wake up every day and go to college believing I was going to be a famous singer and that my life was going to be fantastic,” she recalls. “I thought I could just keep perfecting myself and that someday I would end up as this amazing person surrounded by this amazing life.”

But she also hit severe emotional lows. One came when she realized that the fabulous life she imagined might never come to be. “It was one of the longest periods of depression I've ever gone through,” Tessa tells me. “I became so bitter, and I'm still working through it right now.”

That dissonance between fantasy and reality has spilled into her relationships. When speaking to other people, she often finds herself bored—and in romantic partnerships, especially, she feels disconnected from both her own and her partner's emotions. An ex-boyfriend, after breaking up, told her she'd been oblivious to the hurt she caused him by exploding in rage when he failed to meet her expectations. “I told him, ‘Your suffering felt like a cry in the wind—I didn't know you were feeling that way’ … all I could think about was how betrayed I felt,” she says. It upset her to see him connect with other people; she reacted by degrading his friends and trying to stop him from meeting them. And she hated him admiring other people because it made her question whether he'd continue to see her as admirable.

Not being able to live the idealized versions of herself—which include visions of being surrounded by friends and fans who love and idolize her for her beauty and talent—leaves Tessa profoundly distressed. “Sometimes I simultaneously feel above everything, above life itself, and also like a piece of trash on the side of the road,” she says. “I feel like I'm constantly trying to hide and cover things up. I'm constantly stressed and exhausted. I'm also constantly trying to build an inner self so I don't have to feel that way anymore.” After her parents suggested therapy, Tessa was diagnosed with narcissistic personality disorder (NPD) in 2023.

What makes narcissism particularly complex is that it may not always be dysfunctional. “Being socially dominant, being achievement-striving and focused on improving one's own lot in life by themselves are not all that problematic and tend to be valued by Western cultures,” notes Aidan Wright, a psychologist at the University of Michigan.

Elsa Ronningstam, a clinical psychologist at McLean Hospital in Massachusetts, says the relatively functional variety of narcissism includes having, when things are going well, a positive view of oneself and a drive to preserve one's own well-being, while still being able to maintain close relationships with others and tolerate divergences from an idealized version of oneself. Then there is “pathological” narcissism, characterized by an inability to maintain a steady sense of self-esteem. Those with this condition protect an inflated view of themselves at the expense of others and—when that view is threatened—experience anger, shame, envy and other negative emotions. They can go about living relatively normal lives and act out only in certain situations. Narcissistic personality disorder is a subtype of pathological narcissism in which someone has persistent, long-term issues. It often occurs along with other conditions, such as depression, bipolar disorder, borderline personality or antisocial personality disorder .

The 21st-century Narcissus

In the ancient Greek tale of Narcissus, a young hunter, admired for his unmatched beauty, spurns many who love and pursue him. Among them is Echo, an unfortunate nymph—who, after pulling a trick on one of the gods, has lost her ability to speak except for words already spoken by another. Though initially entranced by a voice that mirrored his own, Narcissus ultimately rejects Echo's embrace.

The god Nemesis then curses Narcissus, causing him to fall in love with his own reflection in a pool of water. Narcissus becomes hopelessly infatuated with his own image, which he believes to be another beautiful being, and becomes distraught when he finds it cannot reciprocate his affection. In some versions of the story, he wastes away before his own likeness, dying of thirst and starvation.

In the 1960s and 1970s psychoanalysts Heinz Kohut and Otto Kernberg sketched what's now known as the “mask model” of narcissism. It postulated that grandiose traits such as arrogance and assertiveness conceal feelings of insecurity and low self-esteem. The 1980 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the main reference used by clinicians in the U.S., reflected this insight by including vulnerable features in its definition of NPD, although it emphasized the grandiose ones. But some psychiatrists contended that the vulnerability criteria overlapped too much with those of other personality disorders. Borderline personality disorder (BPD), in particular, shares with NPD characteristics of vulnerability such as difficulty managing emotions, sensitivity to criticism, and unstable relationships. Subsequent versions of the DSM therefore placed even more weight on grandiose features—such as an exaggerated sense of self-importance, a preoccupation with fantasies of unlimited success and power, an excessive need for admiration and a lack of empathy.

In the early 2000s Aaron Pincus, a clinical psychologist at Pennsylvania State University, noticed that this focus on grandiosity did not accurately represent what he was seeing in narcissistic patients. “It was completely ignoring what typically drives patients to come to therapy, which is vulnerability and distress,” Pincus says. “That got me on a mission to get us more calibrated in the science.” In a 2008 review , Pincus and his colleagues discovered enormous variability in how mental health practitioners were conceptualizing NPD, with dozens of labels for the ways in which narcissism expressed itself. But there was also a common thread: descriptions of both grandiose and vulnerable ways in which the disorder showed up.

Since then, researchers have found that both dimensions of narcissism are linked to what psychologists call “antagonism,” which includes selfishness, deceitfulness and callousness. But grandiosity is associated with being assertive and attention seeking, whereas vulnerability tends to involve neuroticism and suffering from anxiety, depression and self-consciousness. Vulnerable narcissism also more often goes along with self-harm (which can include hairpulling, cutting, burning and related behaviors that are also found in people with BPD) and risk of suicide than the grandiose form.

The two manifestations of narcissism are also linked to different kinds of problems in relationships. In grandiose states, people with NPD may be more vindictive and domineering toward others, whereas in vulnerable phases they may be more withdrawn and exploitable.

Self-Esteem Juice

Jacob Skidmore, a 23-year-old with NPD who runs accounts as The Nameless Narcissist on several social media platforms, says he often flips from feeling grandiose to vulnerable, sometimes multiple times a day. If he's getting positive attention from others or achieves his goals, he experiences grandiose “highs” when he feels confident and secure. “It's almost a euphoric feeling,” he says. But when these sources of ego boosts—something he refers to as “self-esteem juice”—dry up, he finds himself slipping into lows when an overwhelming feeling of shame might stop him from even leaving his home. “I'm afraid to go outside because I feel like the world is going to judge me or something, and it's painful,” Skidmore says. “It feels like I'm being stabbed in the chest.”

The desire to fill up on self-esteem has driven many of Skidmore's more grandiose behaviors—whether it was making himself the de facto leader of multiple social groups where he referred to himself as “the Emperor” and punished those who angered him or forging relationships purely for the sake of boosting his self-esteem. Skidmore hasn't always presented himself in grandiose ways: when he was younger, he was much more outwardly sensitive and insecure. “I remember looking in the mirror and thinking about how disgusting I was and how much I hated myself,” he tells me.

Clinicians' evaluations, as well as studies in the wider population, support the idea that narcissists oscillate between these two states. In recent surveys, Wright and his graduate student Elizabeth Edershile asked hundreds of undergraduate students and community members to complete assessments that measured their levels of grandiosity and vulnerability multiple times a day over several days. They found that whereas vulnerability and grandiosity do not generally coexist in the same moment, people who are overall more grandiose also undergo periods of vulnerability—whereas those who are generally more vulnerable don't experience much grandiosity. Some studies suggest that the overlap may depend on the severity of the narcissism: clinical psychologist Emanuel Jauk of the Medical University of Graz in Austria and his colleagues found in surveys that vulnerability may be more likely to appear in highly grandiose individuals.

Credit: Amanda Montañez; Source: “The Narcissism Spectrum Model: A Synthetic View of Narcissistic Personality,” by Zlatan Krizan and Anne D. Herlache, in Personality and Social Psychology Review , Vol. 22; February 2018

To Diana Diamond, a clinical psychologist at the City University of New York, such findings suggest that the mask model is too simple. “The picture is much more complex—vulnerability and grandiosity exist in dynamic relation to each other, and they fluctuate according to what the individual is encountering in life, the stage of their own development.”

But Josh Miller, a psychologist at the University of Georgia, and others entirely reject the idea that grandiose individuals are concealing a vulnerable side. Although grandiose people may sometimes feel vulnerable, that vulnerability isn't necessarily linked to insecurities, Miller argues. “I think they feel really angry because what they cherish more than anything is a sense of superiority and status—and when that's called into question, they're going to lash back,” he adds. Psychologist Donald Lynam of Purdue University agrees: “I think people can be jerks for lots of reasons—they could simply think they're better than others or be asserting status or dominance—it's an entirely different motivation, and I think that motivation has been neglected.”

These differences in perspective may arise because different types of psychologists are studying different populations. In a 2017 study, researchers surveyed 23 clinical psychologists and 22 social and/or personality psychologists (who do not work with patients) and found that although both groups viewed grandiosity as an essential aspect of narcissism, clinical psychologists were slightly more likely to view vulnerability as being at its core .

Most narcissists who seek help are generally more vulnerable, Miller notes: “These are wounded people who come in to seek treatment for their wounds.” To him, that means clinics might not be the best place to study narcissism—at least not its grandiose aspect. It's “a little bit like trying to learn about a lion's behavior in a zoo,” he says.

The unwillingness to seek therapy is especially true of “malignant narcissists,” who, in addition to the usual characteristics, exhibit antisocial and psychopathic features such as lying chronically or enjoying inflicting pain or suffering on others.

Marianne (whose name has been changed for privacy) recalls her father, a brilliant scientist whom her own therapist deemed a malignant narcissist after reading the voluminous letters he'd sent over the years. (He never sought therapy.) It was “all about constant punishment,” Marianne says. He implemented stringent rules, such as putting a strict time limit on how long their family of five children could use the bathroom during long road trips. If, by the time he'd filled the tank, everyone hadn't returned to the car, he'd leave. On one occasion, Marianne was abandoned at a gas station when she couldn't make it back on time. “There was [hardly] a day without that kind of drama—one person being isolated, punished, humiliated, being called out,” she remembers. “If you cried, he'd say you're being histrionic. He didn't associate that crying with his actions; he thought it was performative.”

Her father also pitted her siblings and their mother against one another to prevent them from forging close connections—and he constantly looked for flaws in those around him. Marianne recalls dinner parties at home where her father spent hours trying to pinpoint weaknesses among the other husbands and to hurt couples' opinions of each other. When Marianne brought home boyfriends, her father challenged them and tried to prove that he was superior. And despite being a dazzling academic who easily charmed people when they first met, he got fired time and time again because of conflicts at the universities where he worked. “It was all about one-upmanship,” she says. “His impulse to destroy anything that was shiny, that was popular, that was loved—it overwhelmed everything else.”

Malignant narcissists often pose the greatest challenge for therapists—and they may be particularly dangerous in leadership positions, Diamond notes. They can have deficient moral functioning while exerting an enormous amount of influence on followers. “I think this is something that's going on right now, with the rise of authoritarianism worldwide,” she adds.

An Adverse Childhood?

Research with identical and nonidentical twins suggests that narcissism may be at least partially genetically heritable , but other studies indicate that dysfunctional parenting might also play a significant role. Grandiosity may derive from caregivers holding inflated views about their child's superiority, whereas vulnerability may originate in having a caregiver who was cold, neglectful, abusive or invalidating. Complicating matters, some studies find overvaluation also plays a role in vulnerable narcissism, whereas others fail to find a link between parenting and grandiosity. “Children who develop NPD may have felt seen and appreciated when they achieved or behaved in a certain way that satisfied a caregiver's expectations but ignored, dismissed or scolded when they failed to do so,” Ronningstam summarizes in her guide to the disorder.

Skidmore attributes his own NPD to both genes and painful childhood experiences. “I've never met a narcissist who has not had trauma,” he says. “People just use love as this carrot on a stick [that] they hang above your head, and they tell you to behave or they'll take it away. And so I have this mindset of, ‘Well then, screw it! I don't need love. I can take admiration, achievements, my intelligence—you can't take those things away from me.’

Many researchers nonetheless say a lot more work is needed to determine what role, if any, parenting plays. Miller points out that most research to date of grandiosity, in particular, has found small effects. Further, the work was done retrospectively—asking people to recall their past experiences—rather than prospectively to see how early life experiences affect outcomes.

There is another way to study what is going on with a narcissist, however: look inside. In a study published in 2015, researchers at the University of Michigan recruited 43 boys aged 16 or 17 and asked them to fill out the Narcissism Personality Inventory, a questionnaire that primarily measures grandiose traits. The teenagers then played Cyberball, a virtual ball-tossing game, while their brain activity was measured using functional magnetic resonance imaging (fMRI), a noninvasive neuroimaging method that enables researchers to observe the brain at work.

Cyberball tests how well people deal with social exclusion. Participants are told that they're playing with two other people, although they are actually playing with a computer. In some rounds, the virtual players include the human participant; in others, the virtual players begin by tossing the ball to everyone but later pass it just between themselves—cutting the participant out of the game.

The teenagers with higher levels of grandiose narcissism turned out to have greater activity in the so-called social pain network than those with lower scores. This network is a collection of brain regions—including parts of the insula and the anterior cingulate cortex—that prior studies had found were associated with distress in the face of social exclusion. Interestingly, the researchers did not find differences in the boys' self-reports of distress. In another revealing fMRI study, Jauk and his Graz colleagues found that men (but not women) with higher levels of grandiose narcissism showed more activity in parts of the anterior cingulate cortex associated with negative emotions and social pain when viewing images of themselves compared with images of close friends or strangers.

The bodies of narcissists bear evidence of elevated stress. Studies indicate that men with more narcissism have higher levels of the stress hormone cortisol than those with less narcissism. In a 2020 study, Royce Lee, a psychiatrist at the University of Chicago, and his colleagues reported that people with NPD—as well as those with BPD—have greater concentrations of molecules associated with oxidative stress (a stress response seen at the cellular level) in their blood.

Such findings suggest that “vulnerability is always there but maybe not always expressed,” Jauk says. “And under particular circumstances, such as in the lab, you can observe signs of vulnerability at a physiological level, even if people say, ‘I don't have vulnerability.’” He adds, however, that these studies are far from the last word on the matter: many of them have a small number of subjects, and some have reported contradicting findings. Follow-up studies, ideally with a larger number of individuals, are needed to validate their results. The neuroscience of narcissism “is incredibly interesting, but at the same time, I'm very hesitant to interpret any of these results,” says Mitja Back, a psychologist at the University of Münster in Germany.

Toward Treatments

To date, there have been no randomized clinical trials for treatments specific for narcissistic personality disorder. Clinicians have, however, begun to adapt psychotherapies that have proved to be effective in other related conditions, such as borderline personality disorder. Treatments currently used include “mentalization,” which aims to help individuals make sense of both their own and others' mental states, and “transference,” which focuses on enhancing a person's ability to self-reflect, take the perspective of others and regulate their emotions. But there is still a dire need for effective treatments.

“People with pathological narcissism and narcissistic personality disorder have a reputation of not changing or dropping off from treatment,” Ronningstam says. “Instead of blaming that on them, the clinicians and researchers need to really further develop strategies that can be adjusted to the individual difference—and at the same time to focus on and promote change.”

Since discovering she has NPD, Tessa has started a YouTube channel called SpiritNarc where she posts videos about her experiences and perspectives on narcissism. “I really want the world to understand [narcissism],” she says. “I'm so sick of the narrative that's going around—people see the outside behavior and say, ‘This means these people are awful.’” What these people don't see, she adds, is the suffering that lies below the surface.

Diana Kwon is a freelance journalist who covers health and the life sciences. She is based in Berlin.

Narcissistic people aren’t just full of themselves – new research finds they’re more likely to be aggressive and violent

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The Research Brief is a short take about interesting academic work.

The big idea

We recently reviewed 437 studies of narcissism and aggression involving a total of over 123,000 participants and found narcissism is related to a 21% increase in aggression and an 18% increase in violence .

Narcissism is defined as “ entitled self-importance .” The term narcissism comes from the mythical Greek character Narcissus , who fell in love with his own image reflected in still water. Aggression is defined as any behavior intended to harm another person who does not want to be harmed, whereas violence is defined as aggression that involves extreme physical harm such as injury or death.

Our review found that individuals high in narcissism are especially aggressive when provoked, but are also aggressive when they aren’t provoked. Study participants with high levels of narcissism showed high levels of physical aggression, verbal aggression, spreading gossip, bullying others and even displacing aggression against innocent bystanders. They attacked in both a hotheaded and coldblooded manner. Narcissism was related to aggression in males and females of all ages from both Western and Eastern countries.

People who think they are superior seem to have no qualms about attacking others whom they regard as inferior.

Why it matters

Research shows everyone has some level of narcissism , but some people have higher levels than others. The higher the level of narcissism, the higher the level of aggression.

People high in narcissism tend to be bad relationship partners , and they also tend to discriminate against others and to be low in empathy .

Unfortunately, narcissism is on the rise, and social media might be a contributing factor. Recent research found people who posted large numbers of selfies on social media developed a 25% rise in narcissistic traits over a four-month period. A 2019 survey by the smartphone company Honor found that 85% of people are taking more pictures of themselves than ever before . In recent years, social media has largely evolved from keeping in touch with others to flaunting for attention .

What other research is being done

One very important line of work investigates how people become narcissistic in the first place. For example, one study found that when parents overvalue, overestimate and overpraise their child’s qualities, their child tends to become more narcissistic over time. Such parents think their child is more special and entitled than other children. This study also found that if parents want their child to have healthy self-esteem instead of unhealthy narcissism, they should give unconditional warmth and love to their child.

Our review looked at the link between narcissism and aggression at the individual level. But the link also exists at the group level. Research has found that “collective narcissism” – or “my group is superior to your group” – is related to intergroup aggression , especially when one’s in-group (“us”) is threatened by an out-group (“them”).

How we do our work

Our study, called a meta-analytic review , combined data from multiple studies investigating the same topic to develop a conclusion that is statistically stronger because of the increased number of participants. A meta-analytic review can reveal patterns that aren’t obvious in any one study. It is like looking at the entire forest rather than at the individual trees.

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• Published: 03 December 2021

Grandiose and vulnerable narcissism, identity integration and self-control related to criminal behavior

• S. Bogaerts   ORCID: orcid.org/0000-0003-3776-3792 1 , 2 ,
• C. Garofalo   ORCID: orcid.org/0000-0003-2306-6961 1 , 2 ,
• E. De Caluwé   ORCID: orcid.org/0000-0001-6639-6739 1 &
• M. Janković   ORCID: orcid.org/0000-0002-7385-8169 1 , 2  

BMC Psychology volume  9 , Article number:  191 ( 2021 ) Cite this article

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Although systematic research on narcissism has been conducted for over 100 years, researchers have only recently started to distinguish between grandiose and vulnerable narcissism in relation to criminal behavior. In addition, there is some evidence suggesting that identity integration and self-control may underlie this association. Therefore, the present study aimed to develop a theory-driven hypothetical model that investigates the complex associations between grandiose and vulnerable narcissism, identity integration, self-control, and criminal behavior using structural equation modeling (SEM).

The total sample ( N  = 222) included 65 (29.3%) individuals convicted of criminal behavior and 157 (70.7%) participants from the community, with a mean age of 37.71 years ( SD  = 13.25). Criminal behavior was a grouping variable used as a categorical outcome, whereas self-report questionnaires were used to assess grandiose and vulnerable narcissism, self-control, and identity integration.

The overall SEM model yielded good fit indices. Grandiose narcissism negatively predicted criminal behavior above and beyond the influence of identity integration and self-control. In contrast, vulnerable narcissism did not have a direct significant effect on criminal behavior, but it was indirectly and positively associated with criminal behavior via identity integration and self-control. Moreover, grandiose narcissism was positively, whereas vulnerable narcissism was negatively associated with identity integration. However, identity integration did not have a direct significant effect on criminal behavior, but it was indirectly and negatively associated with criminal behavior via self-control. Finally, self-control was, in turn, negatively related to criminal behavior.

Conclusions

We propose that both subtypes of narcissism should be carefully considered in clinical assessment and current intervention practices.

Peer Review reports

Introduction

The antecedents of criminality have long been of interest to criminological researchers, as well as factors that mediate the links between them (e.g., [ 1 ]). However, most of the existing studies on personality characteristics and abilities that contribute to the development of criminal behavior have focused on single factors in relation to offending, and integration among studies has often occurred post-hoc via logical inferences (e.g., because construct X is related to construct Y, which in turn is related to criminal behavior, an indirect effect can be logically expected). In the current study, we hence proposed and tested a theory - driven model that focuses on the interplay between narcissism, identity integration, and self-control, in the explanation of criminal behavior .

Despite numerous studies on narcissism, no consensus has been reached on a widely accepted definition of narcissism [ 2 , 3 , 4 ]. However, over the past 20 years, there has been broad recognition of the need to differentiate between different types of narcissism that can be roughly divided into narcissistic grandiosity and narcissistic vulnerability [ 4 , 5 , 6 ]. Although both subtypes of narcissism share a common deeper foundation, such as self-centeredness [ 7 ], they can have very different manifestations. Grandiose narcissism as a pathological characteristic manifests itself in exaggerated self-esteem, grandiosity and an unrealistic sense of superiority, as well as admiration seeking, entitlement and arrogance [ 4 , 6 , 8 ]. Most experts agree that grandiose narcissism is more a characteristic of the Narcissistic Personality Disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders , 5th Edition, Section II (DSM-5; [ 9 ]), than vulnerable narcissism is [ 3 , 5 , 10 ]. In contrast, vulnerable narcissism entails pronounced self-absorbedness, low self‐esteem, hypervigilance, shyness, social withdrawal and emotional hypersensitivity [ 11 , 12 ]. Recent studies have shown that grandiose narcissism is less harmful to mental health, while vulnerable narcissism is associated with psychological problems and the use of rather inappropriate emotion regulation strategies, such as aggression and repression [ 13 ].

In general, research suggests that narcissism is quite overrepresented in samples of violent offenders (e.g., [ 14 , 15 , 16 , 17 ]), and positively associated with criminal behavior [ 18 , 19 ]. However, in the field of forensic psychology, researchers have only recently begun to investigate the difference between grandiose and vulnerable narcissism and no research to date has investigated how both forms differ from one another concerning criminal behavior. Yet, some indirect evidence emerges from studies on grandiose and vulnerable narcissism in relation to aggression, more specifically proactive and reactive aggression. While the results have been somewhat mixed , the available evidence suggests that narcissistic grandiosity is associated with both forms of aggression, while narcissistic vulnerability is associated only with reactive aggression (e.g., [ 20 , 21 , 22 ]). Compared to vulnerable narcissism, grandiose narcissism has also been more strongly associated with a wide variety of impulsivity-related externalizing behaviors, such as gambling [ 23 ], substance use [ 24 ], antisocial behaviors [ 25 ], and proactive aggression [ 26 ]. Individuals with higher levels of grandiose narcissism may have excessive confidence in their competencies and take more risks [ 27 ], probably due to their excessively active reward-oriented system (e.g., [ 28 ]). They focus more on positive outcomes and do not estimate chances and outcomes in a realistic way [ 23 ]. Additionally, aggression in individuals with higher levels of grandiose narcissism is usually seen as a self-enhancing strategy with the aim of restoring or enforcing a sense of superiority [ 29 , 30 ]. However, there is also contrasting evidence suggesting that individuals with high narcissistic vulnerability are more likely to display aggressive behavior than individuals high on grandiosity (e.g., [ 31 , 32 ]). For example, Krizan and Johar [ 31 ] found that narcissistic vulnerability (but not grandiosity) has particularly shown to be a powerful driver of rage, hostility, and aggressive behavior, fueled by suspiciousness, dejection, and angry rumination. The fragmented sense of the self and desperate need for external appreciation predisposes individuals with higher levels of vulnerable narcissism to experience shame about their narcissistic needs and unrestrained anger towards those who exposed their weaknesses [ 33 ]. This, in turn, triggers “narcissistic rage” that can further promote aggressive behavior [ 31 ]. Due to inconsistency and a scarcity of empirical evidence , additional research is needed to uncover whether and how these two subtypes of narcissism are associated with criminal behavior. Indeed, previous research has mainly focused on the link between narcissism and aggressive behavior in samples of the general population. Possible relations of different variants of narcissism with more severe forms of violent behavior (e.g., sanctioned by society) remained largely understudied.

Likewise, little is known about the mechanisms underlying the association between narcissism and criminality. According to Stern [ 34 ], the narcissistic individual is often attuned to what other individuals feel and think. This notion is closely related to the core aspect of identity, namely the fact that the individual is partly determined by interaction with his environment and must develop the ability to act effectively as an independent subject in that environment.

Identity refers to how a person defines the self and understands intimate relationships and social interactions with the social world. Identity formation is a process of alternating phases of ‘crisis and commitment’ that occur especially during adolescence [ 35 ]. Identity integration can be defined as a coherence of identity; the capacity to see oneself and one's life as stable, integrated and purposive [ 36 ]. In contrast, identity diffusion is characterized by a lack of normative commitment and reflects difficulties in maintaining a relatively constant set of goals [ 37 ]. Notably, identity diffusion does not occur in a vacuum; rather, it is an important feature that is associated with various personality dysfunctions and characterizes personality pathology [ 38 , 39 , 40 ]. According to the DSM-5 Section III [ 9 ], significant impairments in self-identity (e.g., unstable self-image, inconsistencies in values, goals, and appearance) and interpersonal functioning (e.g., being insensitive to others, inconsistent, detached, or abusive style of relating) are the main characteristics of personality disorders. In particular, identity diffusion (i.e., incoherent self-image, self-fragmentation) is one of the core components of a narcissistic personality disorder [ 41 , 42 ]. Narcissistic individuals show excessive dependency on others for identity; they need constant external support and attention to maintain their self-esteem, and self-esteem problems often shift between inflated and deflated self-appraisal [ 43 ].

Despite theoretical elaboration of the role of identity in narcissism, there is little empirical research on the association between narcissism and identity integration. However, available evidence suggests that narcissistic traits [ 41 , 44 ], and in particular narcissistic vulnerability [ 39 , 40 , 45 ], are associated with higher identity instability (i.e., a weak sense of the self). For example, Dashineau et al. [ 39 ] found that narcissistic vulnerability was associated with all forms of dysfunction (e.g., well-being, self-control, and everyday life tasks), while grandiosity was associated with specific deficits in interpersonal functioning. However, after accounting for shared variance in vulnerability, grandiosity was not associated with most aspects of poor functioning and was positively associated with better functioning in some areas, such as life satisfaction. Similarly, Huxley et al. [ 40 ] found that vulnerable narcissism was associated with impairment in self- and relational functioning, while grandiosity predicted higher self-functioning. More research is needed to investigate how both grandiose and vulnerable narcissism are associated with identity integration.

Furthermore, it has been shown that identity diffusion can result in feelings of emptiness, deviant behavior and superficiality, or other maladaptive outcomes, such as poor impulse control [ 41 , 42 ]. In the identity-value model, Berkman et al. [ 46 ] proposed that identity plays a crucial role in self-control. By its definition, identity is a relatively stable mental representation of personal and intrapersonal values, priorities, and roles. Therefore, individuals are more prone to associate their identity with long-term goals than with short-term impulses. According to this model, self-control is defined as a decision-making process that compares the subjective value of two options and selects the option with the highest value [ 46 ]. Therefore, individuals with more integrated identity are better at making choices that are relevant to their long-term goals over short-term impulses, meaning they are better at self-control.

Self-control is conceptualized as the capacity to tolerate, use and control one’s own emotions and impulses [ 36 ]. Research has shown that the degree of self-control is positively associated with adaptive correlates in various life domains, such as academic and professional success, healthier and more sustainable intimate relationships, closer social networks, greater self-awareness, empathy, and more proactive health behaviors (e.g., regular medical check-ups; [ 47 ]). In contrast, a lack of self-control is linked to a wide range of antisocial and deviant behaviors [ 48 , 49 , 50 , 51 ], and a variety of negative life outcomes, such as criminal victimization, poor health, and financial difficulties (e.g., [ 52 , 53 , 54 ]).

According to the general theory of crime [ 55 ], a lack of self-control is the main factor behind all criminal acts [ 56 , 57 ], although in this theory self-control was conceptualized in broader terms as “the differential tendency of people to avoid criminal acts whatever the circumstances in which they find themselves” [ 55 p87]. A lack of self-control was thus characterized by impulsive behavior towards others, physical risk-taking and shortsightedness, and can give rise to criminal acts in interaction with situational opportunities [ 55 ].

In sum, there is evidence that grandiose and vulnerable narcissism contribute to disintegrated identity and criminal behavior. In addition, there are indications that identity diffusion is directly associated with criminal behavior and that this association is mediated by self-control. Several studies have reported bivariate associations between pairs of these constructs, as previously reviewed. However, to our knowledge, no studies so far have investigated whether identity integration and self-control sequentially mediate the association between grandiose and vulnerable narcissism and criminal behavior.

The present study

Therefore, the goal of the present study was to develop a theory-driven hypothetical model by using structural equation modeling (SEM) in a cross-section design. Although we cannot test causal relationships in a cross-sectional design, SEM is widely used in social science research to test a hypothetical conceptual model [ 58 , 59 , 60 ]. In this model (see Fig.  1 ), complex associations between grandiose and vulnerable narcissism, identity integration, self-control, and criminal behavior were investigated with specific theory-driven hypotheses about the sequential mediation of identity integration and self-control in the link between narcissism and criminal behavior. First, based on the available evidence [e.g., 20 , 21 , 22 , 25 , 26 ], we hypothesized that both grandiose (path 1) and vulnerable narcissism (path 2) would be directly and positively associated with criminal behavior. However, due to the mixed empirical findings of the extent to which grandiose and vulnerable narcissism contribute to violent offending, we had no specific hypotheses as to which of both narcissistic subtypes on criminal behavior would be stronger. Second, since identity diffusion is one of the key features of a narcissistic personality disorder [ 41 , 42 ], we hypothesized that both grandiose and vulnerable narcissism would be directly and negatively associated with identity integration (path 3 and path 4, respectively). Nonetheless, this link might be expected to be weaker for grandiose narcissism, as grandiose narcissism has been documented to be associated with a narrower range of poor identity functioning and better life satisfaction compared to vulnerable narcissism [e.g., 39 , 40 ]. Furthermore, it has been shown that identity diffusion can lead to deviant behavior and a range of maladaptive outcomes such as poor impulse control [ 48 , 49 , 50 , 51 ]. It also plays a vital role in self-control and individuals with a more integrated identity are better at self-control [ 46 ]. Therefore, it was hypothesized that identity integration would have a direct negative effect on criminal behavior (path 5) and a direct positive effect on self-control (path 6). Lastly, previous research has shown that a lack of self-control is associated with a wide range of antisocial and deviant behavior [ 48 , 49 , 50 , 51 ] and is the main factor behind all criminal acts [ 55 ]. Hence, it was hypothesized that self-control would have a direct negative effect on criminal behavior (path 7). Despite supporting these direct links, the review literature also indicates that there may be indirect effects between these variables. Therefore, a series of indirect effects was assumed. Identity integration and self-control were hypothesized to mediate the association between grandiose narcissism and criminal behavior (path 8 [i.e., paths 3, 6, 7]) and between vulnerable narcissism and criminal behavior (path 9 [i.e., paths 4, 6, 7]). Finally, it was hypothesized that self-control would mediate the association between identity integration and criminal behavior (path 10 [i.e., paths 6 and 7]).

Hypothetical conceptual model. Indirect paths are in the brackets

Master level psychology students who did their clinical internship in three outpatient forensic psychiatric centers recruited the individuals convicted of criminal behavior. All offenders undergo mandatory outpatient treatment in these forensic psychiatric centers which was imposed by the judge as a result of a committed offense. Treatments mainly focused on aggression and emotion regulation based on cognitive behavioral therapy. During a therapeutic session, potential participants were asked if they were willing to participate in the study and also received an information letter. In that letter, it was clearly stated that participation was voluntary and that refusing to participate would not influence the participant’s treatment in any way. The participants had approximately one week to consider their potential participation. Participants who agreed to participate in this study were asked to complete a set of psychosocial questionnaires and were rewarded with monetary compensation of five euros. The questionnaires were completed during a treatment session to cause as little burden as possible to the offenders.

Furthermore, 22 Dutch bachelor and master level psychology students collected data in the community from October 2014 to March 2015. The survey was administered via the Qualtrics platform and made available to the general population through publishing on social media. Participants had to be at least 18 years old and have sufficient knowledge of the Dutch language. Control subjects were matched with the delinquent population on two characteristics, namely age and level of education. Participants with a university degree were excluded from the control group because this category did not appear in a sample of delinquents. After being informed of the goal and procedure of the study by an information letter, all participants signed informed consent and participated voluntarily in the study without receiving financial compensation. Before completing the survey, which included a set of validated psychosocial questionnaires, the participants were asked whether they had ever been convicted of an offense and whether a psychologist, psychotherapist or other care provider had treated them in the past 3 years. If the answer was 'yes', they could not participate in the study. After this, the questionnaires could be completed.

To guaranty anonymity, all participants were instructed to return the questionnaires in a sealed envelope after completion. The sealed envelopes and consent statements were given to the student's supervisor. The informed consent was removed before the data encoding. All procedures involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Committee of Scientific Research of FPC Kijvelanden and the local university ethics review board approved the study.

Participants

The total sample included 222 male participants. Of this sample, 65 (29.3%) were individuals convicted of criminal behavior and 157 (70.7%) were controls from the community. The mean age of the participants was 37.71 years ( SD  = 13.25), ranging from 20 to 60. Most of the participants (67.6%, n  = 150) had a Dutch nationality, lived alone (28.2%, n  = 62) and had an income from paid employment (65.4%, n  = 138). The most common finished level of education was intermediate vocational education/MBO (31.1%, n  = 69), next to higher professional education/HBO (28.4%, n  = 63), higher general secondary education/HVO (9%, n  = 20) and secondary education/VWO (9%, n  = 20). The index offenses of individuals convicted of criminal behavior included a variety of violent offenses: physical aggression (45.3%, n  = 29); domestic violence (31.3%, n  = 20); verbal aggression (20.3%, n  = 13); and other offenses (3.1%, n  = 10). More details about the demographic characteristics of the two groups can be found in the appendix (see Additional file 1 : Table S1). The questionnaire characteristics (including F tests) of the two groups are shown in Table 1 . Compared to the control group, the group of individuals convicted of criminal behavior showed significantly higher levels of vulnerable narcissism and lower levels of grandiose narcissism, self-control and identity integration.

The Dutch Narcissism scale

Narcissism was measured with the Nederlandse Narcisme Schaal ([Dutch Narcissism Scale]; NNS; [ 61 ]). The NNS is based on the Narcissistic Personality Inventory [ 62 , 63 ] and on the Hypersensitive Narcissism scale [ 64 ]. The NNS is a Dutch questionnaire that consists of 35 items measuring three different types of narcissism: vulnerable (11 items), grandiose (12 items) and isolation (12 items). The isolation subscale was not used in this study given its misalignment with our theoretical model. All items are rated on a seven-point Likert scale ranging from 1 “that is certainly not the case” to 7 “that is certainly the case”, with higher scores indicating greater levels of narcissism. An example of a vulnerable narcissism item is: “Small remarks of others can sometimes easily hurt my feelings”. An example of a grandiose narcissism item is: “Sometimes I feel like I got lucky with who I am anyway” [ 61 ]. The validity of the Dutch NNS was supported by its relations with age, self-esteem, burnout, and empathy [ 61 ], meaning of life [ 65 , 66 ], and depression [ 66 ], which paralleled findings obtained with other narcissism inventories. Past research has also demonstrated good internal consistency (Cronbach’s α) of both scales, ranging from 0.71 to 0.77 for grandiose narcissism and from 0.77 to 0.87 for vulnerable narcissism. In the current sample, the internal consistency (Cronbach’s alpha) of the grandiose and vulnerable narcissism scales was acceptable to good with Cronbach’s alpha of α = 0.71 and α = 0.81, respectively. For more details about item means and factor loadings, see Additional file 1 : Table S2 in the appendix.

The severity indices of personality problems: short form

The Severity Indices of Personality Problems—Short Form (SIPP-SF; [ 36 ]) is a 60-item self-report questionnaire derived from the SIPP-118. The SIPP-SF measures five domains of maladaptive personality functioning, namely: self-control (12 items), identity integration (12 items), relational capacities (12 items), responsibility (12 items) and social concordance (12 items). All items are rated on a four-point Likert scale ranging from 1 “fully disagree” to 4 “fully agree”, with higher scores corresponding with greater levels of functioning. For the purpose of the present study, only the domains self-control and identity integration of the SIPP-SF were used. The former assesses the capacity to tolerate, use and control one’s own emotions and impulses, whereas the latter assesses the capacity to see oneself and one’s own life as stable, integrated and purposive [ 36 ]. In the current sample, both domains (i.e., self-control and identity integration) showed excellent internal consistency, with a Cronbach’s α = 0.93 and α = 0.92, respectively. For more details about item means and factor loadings, see Additional file 1 : Table S3 in the appendix.

• Criminal behavior

Criminal behavior was used as a grouping variable (0 = community participants, 1 = sample of offenders), and defined as being convicted of one or more of the following offenses: physical aggression, domestic violence, verbal aggression, violent property offense and stalking. Because we could not have any a-priori theoretical expectation about distinct links with each type of offense as we had no information about the criminal history, and also to maintain statistical power, we deliberately chose this grouping variable of overall offending (referring to violent criminal behavior).

Statistical analysis

All analyses were computed by using the lavaan package in R [ 67 , 68 ] and SPSS version 25.0 [ 69 ]. To determine the bivariate associations between continuous indicators and criminal behavior (i.e., binary outcome variable), we computed the point-biserial correlations. Furthermore, to investigate the interrelation of grandiose and vulnerable narcissism, identity integration, self-control and criminal behavior, path analysis was applied. Path analysis is a subset of SEM and only deals with observed variables. Path analysis was used to investigate whether the assumed theoretical model corresponds to the cross-sectional empirical model that has been studied. A model was estimated with Maximum Likelihood Estimation, which searches for parameter estimates that make probability for observed data maximal [ 70 ]. The model fit was evaluated using the following fit indices: Comparative Fit Index (CFI) and Standardized Root Mean Square Residual (SRMR). The CFI compares the fit of a target model to the fit of a baseline model. Values exceeding 0.90 indicate a well-fitting model. The SRMR represents the square-root of the difference between the residuals of the sample covariance matrix and the hypothesized model. A value less than 0.08 suggests a good model fit [ 71 ]. The minimum sample size for conducting SEM is at least five observations per estimated parameter [ 72 ], which means that we had enough statistical power to detect statistically significant effects. Lastly, missing values were handled with pairwise deletion.

Correlations between all study variables including age are shown in Table  2 . Grandiose narcissism was negatively associated with criminal behavior and positively associated with identity integration and self-control. On the contrary, vulnerable narcissism was positively associated with criminal behavior and negatively associated with identity integration and self-control. Moreover, identity integration was negatively associated with criminal behavior and positively associated with self-control. Finally, self-control was negatively associated with criminal behavior. Considering age, it was negatively associated with both forms of narcissism and positively associated with self-control.

Subsequently, path analysis was performed to investigate the direct and indirect associations between narcissism (i.e., grandiose and vulnerable), identity integration, self-control, and criminal behavior. The data fit sufficiently well with the hypothetical conceptual model based on CFI = 0.98 and SRMR = 0.04. Results are summarized in Table 3 and Fig.  2 . Grandiose narcissism had a significant direct negative path to criminal behavior (path 1), whereas vulnerable narcissism appeared to be non-significantly associated with criminal behavior (path 2). Furthermore, grandiose narcissism had a significant direct positive path to identity integration (path 3), whereas vulnerable narcissism had a significant direct negative path to identity integration (path 4). In addition, identity integration did not have a significant direct path to criminal behavior (path 5), but it had a significant direct positive path to self-control (path 6). Self-control, in turn, had a significant direct negative path to criminal behavior (path 7). Moreover, considering mediating effects, the results showed that identity integration and self-control partially mediated a negative association between grandiose narcissism and criminal behavior (path 8) and fully mediated a positive association between vulnerable narcissism and criminal behavior (path 9). Finally, identity integration was indirectly and negatively associated with criminal behavior through self-control (path 10).

Standardized model results. ** Association is significant at the .01 level (2-tailed). Indirect effects are in the brackets

The present study was the first to investigate the complex associations between grandiose and vulnerable narcissism, identity integration, self-control, and criminal behavior by using SEM. We hypothesized that both grandiose and vulnerable narcissism would have a direct positive effect on criminal behavior and a direct negative effect on identity integration. In addition, we expected identity integration to have a negative effect on criminal behavior, and a positive effect on self-control. Lastly, self-control was expected to be negatively associated with criminal behavior. Furthermore, different mediating effects between these associations were also hypothesized, in a sequential model connecting narcissism to identity integration, self-control, and criminal behavior, in this order. In addition, we also expected that self-control would mediate the association between identity integration and criminal behavior. Overall, the path analysis showed that the empirical model fits well with the proposed theoretical model. However, on the path-level, the results indicated that our expectations were not entirely supported.

Specifically, contrary to our expectations, we found that grandiose narcissism was not positively, but directly negatively associated with criminal behavior (path 1), whereas vulnerable narcissism did not have a significant direct effect on criminal behavior (path 2), despite a small but significant bivariate association. However, by inspecting the indirect effects, it should be noted that vulnerable narcissism was significantly positively associated with criminal behavior, but only via identity integration and self-control (path 9). The same indirect effect was significant for grandiose narcissism as well, yet in the opposite direction, however, without diminishing the direct effect of grandiose narcissism on criminal behavior (path 8). This could lead to the conclusion that higher levels of identity integration and self-control partially explained a negative association between grandiose narcissism and criminal behavior, and lower levels of identity integration and self-control fully explained the positive association between vulnerable narcissism and criminal behavior. Our result is in line with previous finding showing that grandiose narcissism is not necessarily associated with criminal behavior [ 13 ] and that narcissistic vulnerability, but not grandiosity, is a stronger indicator of aggressive behavior and hostility ([ 31 , 32 , 73 ]; but see [ 20 , 22 ]). People high on narcissistic vulnerability often use inappropriate emotion-regulating strategies, which might lead to more anger and aggression (e.g., 13, [ 31 , 32 ]). However, in the present study vulnerable narcissism predicted criminal behavior only indirectly.

A lack of a direct effect of vulnerable narcissism on delinquency (path 2) in our study might be explained by the design of the study. In other words, it is likely that previous studies that found a direct association between vulnerable narcissism and criminal behavior did not include mediators in the model. Here, with identity integration and self-control in our model, all association between vulnerable narcissism and criminal behavior goes through identity integration and self-control. It is not necessary that these individuals do not express aggression openly/directly, as the criminal behavior itself can be overt and direct. The statistical effect is not direct because we control for identity and self-control, which may be mechanisms linking vulnerable narcissism and criminal behavior.

Furthermore, the present study revealed that higher levels of grandiose narcissism and lower levels of vulnerable narcissism were associated with a more integrated identity (path 3 and 4, respectively). Consistent with our hypothesis, we found that vulnerable narcissism was associated with lower levels of identity integration. It might be that individuals high on narcissistic vulnerability have a lower integrated identity because they are more likely to maintain their self-esteem and to modulate their fragile ego by relying on the social approval of significant others [ 74 ]. It has also been shown that, with positive feedback, individuals with high levels of vulnerable narcissism can hide the negative and shameful self-image, but when external feedback is perceived as negative, they are forced to face their negative self-image and are deeply ashamed. In contrast, negative feedback does not affect the positive self-image of individuals with grandiose narcissistic traits [ 75 ].

Contrary to our expectations, grandiose narcissism was positively associated with identity integration (path 3) namely with a self-representation of oneself and one’s own life as stable, integrated, and purposive. It might be that individuals high on narcissistic grandiosity have a higher integrated identity because they are more likely to maintain their self-esteem by employing overt strategies, such as self-enhancement and devaluation of others [ 30 ]. The result may fit into previous studies showing that individuals with grandiose narcissistic traits are better adjusted compared to individuals with vulnerable narcissistic traits [ 39 , 40 , 45 , 76 , 77 , 78 ]. For example, Ng et al. [ 76 ] found that grandiose narcissism predicted higher life satisfaction and lower perceived stress, whereas vulnerable narcissism showed the opposite pattern. It has been also shown that the agentic extraversion, a characteristic of grandiose narcissism (i.e., a tendency toward assertiveness, persistence, and achievement), may serve as a protective factor against psychopathology and thus contribute to higher well-being and the “happy face” of narcissism [ 77 ]. This could explain why individuals high on grandiosity are satisfied with their lives, although they remain potentially harmful to others [ 45 ].

Furthermore, identity integration did not have a direct significant negative effect on criminal behavior (path 5), which is not in line with our hypothesis. However, identity integration was significantly negatively associated with criminal behavior, but only indirectly via self-control (path 10). Due to the fact that there was a significant negative correlation between identity integration and criminal behavior, this could lead to the conclusion that self-control fully explained the association between identity integration and delinquency. Indeed, it has been shown that individuals with higher identity integration have better self-control and are therefore less likely to engage in criminal behavior [ 46 ].

In support of this evidence, we found that better-integrated identity was associated with higher levels of self-control (path 6), which in turn was negatively related to delinquency (path 7). Identity can be seen as a strong and enduring source of value, which has an important role in determining self-regulation and self-control outcomes [ 46 ]. Our result corresponds with previous findings showing that lower identity integration can be manifested through poor self-control [ 41 , 46 ]. In addition, a lack of self-control has been linked to a wide range of antisocial and deviant behaviors [ 46 , 47 , 48 , 49 , 50 , 51 , 56 ]. Finally, our findings also give support to the general theory of crime [ 55 ], in which a lack of self-control represents the most important explanatory factor behind criminal behaviors.

Limitations

Several limitations should be considered while interpreting the results of the present study. First, the current study was limited by operationalizing criminal behavior as a dichotomous variable, as well as by a relatively small sample of 65 offenders and 157 controls, which might negatively affect statistical power and effect size. Second, the study sample included only male participants and therefore our findings are not generalizable to the population of females. In addition, convenience sampling was used to recruit the subsample of controls and hence the generalizability of the findings cannot be entirely justified. Third, to maintain statistical power, we did not include any covariates in the analysis, which may also influence the results. In the current sample, however, age was significantly associated with both forms of narcissism and with self-control. There were also significant differences in social status, educational level and income between controls and offenders (Additional file 1 : Table S1). Future studies may consider including age and other demographic characteristics as covariates when examining these complex associations. Furthermore, different narcissism inventories operationalize grandiose narcissism differently; therefore, we can only conclude that the effects reported relate to the NNS operationalization of narcissism and call for replications with other measures of this construct. Lastly, the design of the study was cross-sectional, which does not allow us to draw causal inferences about the complex associations between grandiose and vulnerable narcissism, identity integration, self-control, and criminal behavior.

Research and clinical implications

Despite the limitations mentioned above, this study could have important research and clinical implications. To the best of our knowledge, the interrelation of identity integration, narcissism, and self-control explaining criminal behavior has never been tested before. In this study, we emphasized the role of personality pathology in the development of disintegrated identity. In addition, this study demonstrated the importance of considering identity integration and self-control as significant factors underlying the association between narcissism and criminal behavior. Future studies should investigate the long-term relations between grandiose and vulnerable narcissism, identity integration, self-control, and criminal behavior. The findings of the current study may be of significant value for future intervention practices. So far, most studies on narcissism in forensic psychiatry have treated narcissism as a unidimensional construct. However, there is some evidence that grandiose and vulnerable narcissism should be treated independently, as they are differently associated with adverse outcomes, such as criminal behavior, as well as victimization [ 79 ]. Therefore, the differences between these two subtypes of narcissism should be carefully considered in clinical assessment and intervention practices.

This study can deepen our understanding of the complex associations between different aspects of narcissism, identity integration, self-control, and criminal behavior. In particular, the findings of the present study revealed that grandiose narcissism can be seen as a better-adjusted subtype of narcissism, as it was associated with higher identity integration and non-criminal behavior. In contrast, vulnerable narcissism was associated with low identity integration and indirectly associated with criminal behavior. Moreover, our study showed that identity integration and self-control are important mediators in the association of both grandiose and vulnerable narcissism with criminal behavior. Finally, this research confirmed the importance of identity integration in potentially contributing to self-control, which in turn is highly relevant for deterring criminal behavior. Researchers may wish to confirm our conclusions in a larger and more representative sample, and the current study serves as a good starting point for further work.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Structural equation modeling

Nederlandse Narcisme Schaal [Dutch Narcissism Scale]

Severity indices of personality problems – short form

Severity indices of personality problems – 118

Comparative fit index

Standardized root mean square residual

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Bogaerts, S., Garofalo, C., De Caluwé, E. et al. Grandiose and vulnerable narcissism, identity integration and self-control related to criminal behavior. BMC Psychol 9 , 191 (2021). https://doi.org/10.1186/s40359-021-00697-1

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Are narcissists resilient? Examining grandiose and vulnerable narcissism in the context of a three-dimensional model of resilience

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In this paper, we focused on the poorly understood and rarely researched relationship between resilience and narcissism, adopting the adjective-based measures of narcissism. We examine how levels of resilience are related to grandiose and vulnerable narcissism, based on a three-dimensional model of resilience (i.e., ecological resilience, engineering resilience, and adaptive capacity). Using self-report, cross-sectional data from a general Polish sample ( N  = 657), we found that grandiose narcissism was positively related to all three dimensions of resilience, while vulnerable narcissism was negatively related to them. Grandiose narcissism was most strongly associated with adaptive capacity where vulnerable narcissism was mostly strongly associated with engineering resilience. We discuss our findings in relation to the function of two forms of narcissism may yield different capacities for stress management and recovery after experiencing stressful events. Therefore, this research is focused on self-report and we look forward to expand our research by behavioral indices in the future.

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Introduction

Narcissism is a well-examined trait in psychology (e.g., Krizan & Herlache, 2018 ; Miller et al., 2017 ). Despite various controversies in the concept and definition of this trait (Miller et al., 2017 ), researchers commonly agree that it is multidimensional, with different forms or dimensions (Krizan & Herlache, 2018 ), and different consequences for human functioning (Dufner et al., 2019 ). One of the most important distinctions is that of grandiose and vulnerable narcissism (Wink, 1991 ). Grandiose narcissism is typically conceptualised as self-absorbed self-aggrandisement (Morf & Rhodewalt, 2001 ), while vulnerable narcissism refers to feelings of inadequacy and incompetence (Miller et al., 2011 ). The core of narcissistic personality is entitled self-importance (Krizan & Herlache, 2018 ) and feeling of uniqueness (Freis, 2018 ).

Grandiose narcissism is positively related to better psychological functioning, while vulnerable narcissism is related to poorer psychological functioning (Dufner et al., 2019 ; Sedikides, 2020 for review). However, mechanisms explaining these differences are less known, suggesting self-esteem as a crucial factor (Sedikides et al., 2004 ). In the current paper, we propose resilience as another important factor, explaining the difference between the levels of subjective well-being among people with high levels of grandiose and vulnerable narcissism.

Resilience can be understood as a personality trait (Maltby et al., 2015 ), defined as the ability to maintain equilibrium as a healthy state of the individual (Maltby et al., 2015 , 2016 ). Therefore, we focus on resilience understood as an individual difference, contrary to that models which describe resilience as a feature of the social-ecological system (Folke et al., 2010 ; Walker et al., 2004 ). Coping effectively with traumatic life events, unexpected occurrences, stress (Holling, 1973 ; Maltby et al., 2015 ), and chronic pain (Sturgeon & Zautra, 2010 ) is the essence of resilience. Resilience correlates positively with mental health and subjective wellbeing (Davydov et al., 2010 ; Samani et al., 2007 ).

Maltby et al. ( 2015 ) proposed three-dimensional model of resilience, indicating engineering resilience as the ability of a person to recover, stabilize their mental or life state, and returning to equilibrium following any disturbance in everyday events. A person characterized by high level of engineering resilience is more capable to cope after occurrence of stressful event. Ecological resilience is the ability to resist disturbances while maintaining equilibrium, and not allowing to perturb stable mental state of the individual, while making necessary changes to our psychical defence mechanisms, it is also accompanied by self-confidence in one’s strengths. A person characterized by high level of ecological resilience resists stress more effectively, by keeping their stable state of mind against any disturbance. It means that stress does not bother such person as much as a person who has low level of ecological resilience. Adaptive capacity is the ability to adapt to unpleasant, hard or unstable conditions, to manage or accommodate to the change (Maltby et al., 2015 ; Walker et al., 2004 ) and general willingness to adapt across life (Maltby et al., 2016 ). An individual characterized by high level of adaptive capacity is more capable to face unpleasant situations by adapting his/her mind to them. For example, while moving out, it is easier for such person to accommodate to new surroundings.

There is a considerable amount of research on subjective well-being and narcissism (e.g., Dufner et al., 2019 ; Rose, 2002 ; Zuckerman & O’Loughlin, 2009 ). However, there is only a limited amount of research on narcissism and resilience (Buyl et al., 2017 ; Kauten et al., 2013 ), despite the fact that resilience has proved to exert an effect on life satisfaction (Samani et al., 2007 ), subjective well-being, and self-reported health (Maltby et al., 2015 ). Therefore, examining the relationship between narcissism and resilience may shed light on the capacity of narcissists to manage stress and recover after experiencing stressful events, supplementing the studies on psychological functioning and narcissism.

In the current paper, we examine the relationships between two forms of narcissism (i.e., grandiose and vulnerable; Miller et al., 2017 ) and three broad forms of resilience (i.e., engineering resilience, ecological resilience, and adaptive capacity; Maltby et al., 2015 ). These three dimensions of resilience have distinct personality correlates and are responsible for distinct aspects of coping with stress and adaptation to the environment. For instance, engineering resilience is related mostly to not experiencing negative emotional states, ecological resilience is based on feelings of self-confidence and perceived control under environment, and adaptive capacity is between them both, being weakly related both to emotions and to coping (Maltby et al., 2015 ). This distinction is particularly useful in examining how people with high grandiose and vulnerable narcissism could be resilient toward stressful events and adapt to the environment.

Resilience and Its Relationship with Psychological Functioning

The three original forms of system resilience (i.e. engineering resilience, ecological resilience, and adaptive capacity) were reformulated to describe resilience as a multi-dimensional personality trait (Maltby et al., 2015 ). All three dimensions of resilience correlated positively with subjective well-being and extraversion, correlated negatively with neuroticism, and they were uncorrelated to avoidance coping. Only engineering resilience and ecological resilience were positively related to approach coping. Engineering resilience correlated stronger to neuroticism than ecological resilience and adaptive capacity. Ecological resilience correlated positively also with agreeableness, and ecological resilience correlated positively with conscientiousness (Maltby et al., 2015 ). Adaptive capacity was uniquely positively related to openness to experience (Maltby et al., 2016 ).

The usefulness of distinguishing three separate dimensions of resilience has been revealed in their different nomological network (Maltby et al., 2015 , 2016 ). Neuroticism is associated with experiencing negative emotional states, while extraversion is related to focus on others, activity and optimism (Costa & McCrae, 1992 ). Therefore, engineering resilience seems to be the most emotionally-based dimension of resilience (because strong negative relationship with neuroticism), and it seems less proactive aspect of coping with stressful events due to its weak correlation with extraversion and lack of correlation with approach coping. Ecological resilience seems to be crucial in active managing with environment, as it indicates the strongest relationships to coping and to subjective well-being. As adaptive capacity is responsible for adapting to the change rather than initializing any activity, itis a rather passive aspect of resilience. Congruent with this assumed passivity it is weakly correlated to subjective well-being, uncorrelated with physical health, and its relationship with coping strategies are weak (Maltby et al., 2015 ). Ecological resilience is responsible for recovery after stressful events, while adaptive capacity and engineering resilience are responsible for dealing with ongoing stress by accommodation (engineering resilience), and general readiness to accept changes (adaptive capacity; see Maltby et al., 2015 , 2016 ). Therefore, all three dimensions could be divided into proactive and flexible, like ecological resilience and passive, unrelated to activity, like adaptive capacity and engineering resilience.

Conceptualisation of Narcissism and Its Relationship with Psychological Functioning and Resilience

Grandiose narcissism is considered as rather intrapersonally healthy (Dufner et al., 2019 ), because of its positive correlations with high self-esteem (Rohman et al., 2019 ), psychological health (Ng et al., 2014 ), and subjective well-being (Zuckerman & O’Loughlin, 2009 ). Grandiose narcissism is also positively correlated to extraversion and negatively correlated to agreeableness and neuroticism (Miller et al., 2011 ). Grandiose narcissism is also related to lower perceived stress, which may be important to a person’s health and well-being (Ng et al., 2014 ). Positive correlation between grandiose narcissism and subjective well-being is mostly due to the result of the mediating effect of self-esteem (Sedikides et al., 2004 ). In addition, self-enhancement is beneficial for intrapersonal adjustment, yet it is not beneficial for social functioning (Dufner et al., 2019 ). Grandiose narcissism has some important similarities to high self-esteem, especially assertiveness and agency (Hyatt et al., 2018 ). The way of perceiving others and themselves by narcissistic individuals and people with high self-esteem is different, as the former undervalue others and overvalue themselves, while the latter just value themselves in positive way (Brummelman et al., 2018 ). The differences between self-esteem and grandiose narcissism seem to be crucial for understanding why grandiose narcissists could indicate higher resilience, but also point to possible downsides in managing stressful events. Higher levels of agency could help in dealing with stressful events, but on the other hand biased perception of the self and others could lead to unrealistic beliefs in own capacity, and evoke conflicts with others. Finally, grandiose narcissism is associated with increased motivation to action, also under social pressure or under self-threat (Sedikides, 2020 ), which could result in higher levels of resilience.

Contrary to this, vulnerable narcissism is accompanied by shyness, the impulsiveness of aggressive behaviour (Freis et al., 2015 ), and low self-esteem (Rohmann et al., 2019 ). Vulnerable narcissist manifests higher levels of neuroticism and lower levels of extraversion and agreeableness (Miller et al., 2011 ). People characterized by this type of narcissism, like grandiose narcissism, are often self-absorbed and desire approval, but lack the skills needed to obtain them (Freis et al., 2015 ). Such a set of features is interpersonally maladaptive (Hill & Lapsley, 2011 ). In addition, people with higher levels of vulnerable narcissism have less psychological health and higher perceived stress (Ng et al., 2014 ), as well as many negative emotions and emotional lability (Hill & Lapsley, 2011 ). The crucial factor involved in poorer psychological functioning of the vulnerable narcissists, including lower resilience, could be lack of agency and low self-esteem (Rohmann et al., 2019 ), what makes them less resistant to self-threats (Sedikides, 2020 ).

According to the mask model of narcissism, narcissists are hypersensitive to ego-threats and they “mask” their fragile self via grandiosity and intrapersonal exploitativeness (Sedikides, 2020 ). Form of narcissism (i.e., grandiose versus vulnerable) could be associated with the strength of the reaction toward threat and the way how narcissistic individuals restore their equilibrium. Grandiose narcissists indicate higher self-promotion focus, while vulnerable narcissist indicate higher avoidance and self-protection focus (Krizan & Herlache, 2018 ), as such vulnerable narcissist react stronger and in more passive way to the threats, which could result in lower resilience (Sedikides, 2020 ).

To date, there is a limited amount of research on the relationship between narcissism and resilience. Moreover, former researchers (1) did not distinguish overly between grandiose and vulnerable narcissism (Kauten et al., 2013 ; Yun & Min, 2018 ); (2) used rather non-traditional methods for assessing narcissism (Buyl et al., 2017 ; Kauten et al., 2013 ); (3) examined specific populations, like adolescents (Yun & Min, 2018 ; Kauten et al., 2013 ), MBA students (Wu et al., 2019 ) or general directors in banks (Buyl et al., 2017 ). For instance, Kauten, et al. ( 2013 ) used only a questionnaire examining narcissism related to psychopathy (Antisocial Process Screening Device; Frick & Hare, 2001 ) among adolescents, and did not find a correlation between (grandiose) narcissism and resilience, while Buyl et al. ( 2017 ) assessed CEO’s narcissism basing on behavioural indicators, like the prominence of the CEO’s photograph in the annual report. Yun and Min ( 2018 ) also examined only adolescents, revealing a negative correlation between narcissism and resilience. Buyl et al. ( 2017 ) examined the grandiose narcissism of general directors in banks and their psychological resilience. However, the researchers discussed resilience levels based on the propensity to recover after business failures which may be prohibitively narrow. Wu et al. ( 2019 ) examined the relationship between Dark Triad and resilience in the context of sustainable entrepreneurial orientation, finding that narcissism was unrelated with psychological resilience.

The Current Study

The relationship between resilience and narcissism (especially narcissism subtypes) is poorly understood. Former research on resilience and narcissism used only one-dimensional models of resilience and narcissism examining mainly adolescents or specific professional groups (Buyl et al., 2017 ; Kauten et al., 2013 ). Former studies were limited to Western populations, which could be specific, at least in relation to narcissism (Foster et al., 2003 ). One of the important limitations of the former studies was the way how the trait narcissism was assessed. In the current study we decided to use the adjective-based measures of narcissism, namely Narcissistic Grandiosity Scale (Crowe et al., 2016 ) and Vulnerable Grandiosity Scale (Crowe et al., 2018 ). Using both of these scales allow for clear separation between grandiose and vulnerable narcissism, and they indicate clear and strong associations with the most widely used scales measuring narcissism (Edershile et al., 2019 ).

People with high grandiose narcissism report higher levels of subjective well-being (Rose, 2002 ) and their tend to be proactive (Foster & Trimm, 2008 ), therefore we expect that they also indicate higher levels of resilience. Because grandiose narcissists have high levels of activity and self-confidence (Rohmann et al., 2019 ), and their enhanced subjective well-being is mostly a function of their higher self-esteem (Sedikides et al., 2004 ) we expect that they manifest especially higher levels of ecological resilience as that dimension of resilience is related to activity and self-confidence.

As people with high vulnerable narcissism indicate lower levels of subjective well-being, mostly due to experiencing higher levels of negative emotions (Hill & Lapsey, 2011 ; Rose, 2002 ), we expect that they indicate lower levels of resilience. We expect that vulnerable narcissists manifest especially low levels of engineering resilience, as this aspect of resilience trait seems to be a protective factor against experiencing negative emotional states. People with high vulnerable narcissism report problems with their emotional states (Hill & Lapsley, 2011 ) and increased levels of neuroticism (Miller et al., 2011 ), so that we predict that their lower levels of resilience manifests mostly in emotional aspect.

Material and Methods

Participants and procedure.

We administered a two-wave survey to a general sample of 1100 Polish adults via the Ariadna online research panel. The waves were separated by 1 week. We separated measuring dependent and independent variables to control common-method bias and used randomized order of scales for each participant (Podsakoff et al., 2012 ). Our final sample comprised 657 participants: 372 women, 285 men ( M age  = 45.31 years, SD  = 15.38). Aged 18 to 82 after excluding 443 respondents who did not take part in the second wave or failed to answer correctly an one of attention check item (e.g., ‘ Please select response option 5 ’). Respondents were rewarded by loyalty points in Ariadna online research panel. All procedures were approved by the institutional ethics board (KEiB – 10/2018). Data are available at https://osf.io/2xeyb/ .

Vulnerable Narcissism

We assessed vulnerable narcissism with a one-dimensional 11-item adjective scale – Narcissistic Vulnerability Scale (e.g., ‘ Underestimated’ or ‘Ashamed’; Crowe et al., 2018 ). The scale was translated and back translated for the purpose of current study (see Supplementary Materials). The response options ranged from 1 ( strongly disagree ) to 7 ( strongly agree ).

Grandiose Narcissism

We assessed grandiose narcissism with a one-dimensional 13-item adjective scale – Narcissistic Grandiosity Scale (e.g., ‘ Perfect’ or ‘Heroic’; Crowe et al., 2016 ). The scale was translated and back translated for the purpose of current study (see Supplementary Materials). The response options ranged from 1 ( strongly disagree ) to 7 ( strongly agree ).

We assessed resilience with the EEA Resilience Scale which contains three subscales: Ecological resilience (e.g., ‘ I give my best effort no matter what the outcome may be’ ); engineering resilience (e.g., ‘ Does not take a long time to recover’ ) and adaptive capacity (e.g., ‘ I enjoy dealing with new and unusual situations ’). The EEA is 12-item measure (Maltby, Day, & Hall, 2015 ; see Maltby et al. 2016 ; Sękowski et al, 2018 , for the Polish version). The response options ranged from 1 ( strongly disagree ) to 4 ( strongly agree ). Higher scores on each of the resilience subscales indicate higher level of resilience.

Descriptive Statistics, Internal Consistency Estimates, and Zero-Order Correlations

Descriptive statistics, reliability estimates, and zero-order correlations for all variables are presented in Table 1 . We also conducted a post hoc power analysis instead of an ad hoc power analysis, because of the lack of prior research on the relationship between resilience and narcissism. Therefore, we calculated power using the effects from current study. We obtained the following results: for all significant effects, the power was above 0.97. Sensitivity analysis indicated that we are able to detect effects r  = .10 assuming power equal .80. The power was calculated with the GPower program version 3.1.9.4 (Erdfelder, Faul, & Buchner, 1996 ).

Three forms of resilience were correlated. Grandiose and vulnerable narcissism were positively, yet weakly, correlated. Grandiose narcissism was positively correlated to ecological resilience and adaptive capacity but not to engineering resilience. Vulnerable narcissism was negatively correlated to all dimensions of resilience. Resilience was unrelated with sex and age. Men indicated higher levels of grandiose narcissism. Both grandiose and vulnerable narcissism was negatively related with age. To compare the strength of the correlations, z -tests for dependent samples were performed using an online calculator (Eid, Gollwitzer, & Schmitt, 2011 ). Results are presented in Table 2 . We have found that grandiose narcissism was related (positively) more strongly with ecological resilience followed by adaptive capacity, and with weakest relation with engineering resilience. Vulnerable narcissism was related (negatively) more strongly with engineering resilience and adaptive capacity than ecological resilience.

Relationship between Grandiose Narcissism, Vulnerable Narcissism, and Resilience

Basing on our hypotheses regarding relationship between two forms of narcissism and three dimensions of resilience we tested a Structural Equation Model using mPlus with Robust Maximum Likelihood estimation, and relied on common cut-off recommendations for good fit (Byrne, 1994 ): Comparative Fit Index (CFI) > 0.90, Root Mean Square Error of Approximation (RMSEA) < 0.08, and Standardized Root Mean Square Residual (SRMR) < 0.10.

We based our measurement model for vulnerable and grandiose narcissism on the parcels constituted by two up to three items (Matsunaga, 2008 ) and on single items for three correlated latent factors corresponding to three dimensions of resilience. We introduced participants’ age and sex as covariates. The model (Fig.  1 ) fit the data well (χ2[25] =789.71, p  < .001, CFI = 0.91, RMSEA = 0.06 [.05; .06]; p  < .008, SRMR = 0.06). We conducted the power analysis calculation which was equal to 1.00 (McCallum et al., 1996 ). Higher levels of grandiose narcissism was positively related with all dimensions of resilience, while higher levels of vulnerable narcissism was related with all dimensions of resilience negatively. There were no sex differences in the narcissism levels and two of three dimensions of resilience. Men indicated higher levels of engineering resilience than women. Younger participants indicated higher levels of grandiose and vulnerable narcissism, while resilience was unrelated with age.

Standardized path coefficients in the structural model in which grandiose and vulnerable narcissism predict three-factor resilience (with controlling for participants’ sex and age). * p  < .05; ** p  < .001. Note. Only significant paths for sex and age are displayed in the model

In the current study we examined the relationships between grandiose and vulnerable narcissism and three-dimensional resilience. Grandiose and vulnerable narcissism were weakly positively correlated to each other, despite that these are often assumed to be relatively orthogonal (see Krizan & Herlache, 2018 for discussion). This result could be caused by common method bias, but it also could be a result of the content the Narcissistic Grandiosity Scale, which not only refers to grandiose narcissistic traits, but also taps into antagonism (Weiss et al., 2019 ).

Grandiose narcissism was positively correlated to all dimensions of resilience. Ecological resilience and adaptive capacity had the strongest relation with grandiose narcissism. Both adaptive capacity and ecological resilience are responsible for preventing the individual from disturbances caused by changes in the environment (Maltby et al., 2015 ). Regression analyses detected suppression effect for engineering resilience, suggesting that this dimension is related uniquely to narcissistic grandiosity (after partialling out its shared variance with vulnerable narcissism). As grandiose narcissism is predominantly agentic (Grijalva & Zhang, 2016 ); it is therefore particularly relevant for agentic aspects of resilience, especially engineering resilience allowing for recovery after experiencing stressful events. Our findings suggest that grandiose narcissism is accompanied by a general capacity to adapt and being resistant to stressful events rather than to recover after experiencing stress. As adaptive capacity is positively related to openness to experience, probably grandiose narcissists perceive changes in the environment as less stressful.

On the other hand, vulnerable narcissism is negatively correlated to ecological resilience, engineering resilience, and adaptive capacity. As predicted, engineering resilience has the strongest relation to vulnerable narcissism. This result can be explained by the highest negative correlation being between engineering resilience and neuroticism (Maltby et al., 2015 ) which, in turn, is positively correlated with vulnerable narcissism (Miller et al., 2011 ). Vulnerable narcissism is considered as more passive than grandiose narcissism (Freis et al., 2015 ), which can be an explanation for the stronger negative correlation between vulnerable narcissism and engineering resilience than analogue correlations between the other dimensions of resilience and vulnerable narcissism. Therefore, it seems that vulnerable narcissists experience problems with a recovery after stressful events because of their lack of agency.

Limitations and Future Directions

The current study is based on self-report data, which is a limitation, especially given that narcissistic individuals have a biased image of themselves (Gabriel et al., 1994 ). There is still a need for further research about narcissism and resilience not only on self-report data but also on behavioural or psychophysiological data, which can provide a better understanding of the relation of narcissism and resilience. Our research was conducted in the Polish culture, which could affect generalisation of the findings, as Poland is an European, affluent and moderately individualistic country (see Henrich et al., 2010 ). However, Polish cultural context offers an opportunity to extend former research by including the less-studied population of Central Europe, not so highly individualistic as English-speaking societies (Hofstede et al., 2010 ). Both narcissism and resilience were studied cross-culturally before; these results suggested that at least grandiose narcissism is present in individualistic and collectivistic countries (Foster et al., 2003 ), and the resilience model is also replicable across cultures, including Poland (Maltby et al., 2016 ). Preliminary studies suggest that Poles indicate rather lower levels of grandiose narcissism than other populations, at least regarding student samples (Jonason et al., 2020 ). On the other hand, it is impossible to state whether the resilience level is related to individualism-collectivism dimension, because of lack of measurement invariance between compared cultures (i.e., Poland, Japan, and the UK), allowing for reliable comparisons in the resilience levels (see Maltby et al., 2016 ).

Further studies could search for possible mechanisms involved in the link between narcissism and resilience. Grandiose narcissists could indicate higher levels of resilience because of its activity aspect, accompanied by higher self-confidence and self-esteem, therefore ecological resilience is the most important aspect of resilience among grandiose narcissists. Moreover, grandiose narcissists perceive less stress, while vulnerable narcissists perceive more stress (Papageorgiou et al., 2019 ). Our study suggests that people with higher levels of grandiose narcissism are more resilient mostly because they are more ready to accept changes and they indicate higher ability to be resistant to stressful events. However, their ability to recover after experiencing stress is a less important aspect of their resilience. Therefore, it is possible that people with higher levels of grandiose narcissism perceive the environment as more controllable than people with higher levels of vulnerable narcissism (Papageorgiou et al., 2019 ) what in turn result in their higher resilience.

Vulnerable narcissists seem to have lower levels of resilience mostly because of their higher frequency and intensity of experiencing negative events (see Miller et al., 2018 ), what is reflected with strongest negative relations with engineering resilience. Therefore, the most problematic aspect of their resilience is related to lower levels of agency and problems with recovery after experiencing stress rather than with the more general negative self-perception. However, these assumptions require further research.

Our findings provide some possible recommendations for clinical practice, pointing the different source of resilience among people with higher levels of grandiose and vulnerable narcissism, respectively. Grandiose narcissists manifest greater belief in their capacity to deal with stressful events and they are more open to the changes in the environment. Such beliefs could increase their subjective well-being (Dufner et al., 2019 ; Papageorgiou et al., 2019 ). On the other hand, vulnerable narcissists indicate lower ability to recover after stressful events, therefore they could exaggerate the problems and react more strongly to negative situations. As a result, vulnerable narcissists require more professional help, encouraging them for active dealing with a problematic situation and lowering the levels of experienced stress by restoring the self-confidence.

Conclusions

Our findings supplement knowledge about functioning of people with higher levels of vulnerable and grandiose narcissism with respect to their ability to maintain equilibrium and a healthy state. People with higher levels of grandiose narcissism displayed higher levels of resilience, mostly through ecological resilience, which could be considered as active dimension and greater self-confidence, reflected in higher levels of adaptive capacity. Vulnerable and grandiose narcissism operate in the opposite way in regard to engineering resilience, as uniquely grandiose aspect of narcissism is associated with better recovery, while uniquely vulnerable aspect suppresses this positive effect of grandiose narcissism. Vulnerable narcissists displayed lower levels of resilience, mostly through emotional dysregulation (as expressed especially in lower levels of engineering resilience), which could explain their lower ability to manage stressful events and resulting lower subjective wellbeing. In addition, we used the adjectively-based measures of narcissism what allow for assessing both global levels of narcissism and fluctuations in this trait (Edershile & Wright, 2019 ). Therefore, possible replications of the current study could employ Experience Sampling Method (Edershile & Wright, 2019 ) to direct compare the global levels and fluctuations of narcissism in the context of resilience.

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Acknowledgements

We would like to thank John Maltby and Peter Jonason for commenting the manuscript.

This study was funded by Polish National Science Centre (grant number 2017/26/E/HS6/00282).

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Sękowski, M., Subramanian, Ł. & Żemojtel-Piotrowska, M. Are narcissists resilient? Examining grandiose and vulnerable narcissism in the context of a three-dimensional model of resilience. Curr Psychol 42 , 2811–2819 (2023). https://doi.org/10.1007/s12144-021-01577-y

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Living with pathological narcissism: a qualitative study

• Nicholas J. S. Day 1 ,
• Michelle L. Townsend 1 &
• Brin F. S. Grenyer 1  

Borderline Personality Disorder and Emotion Dysregulation volume  7 , Article number:  19 ( 2020 ) Cite this article

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A Correction to this article was published on 22 January 2022

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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.

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.

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.

Introduction

The current diagnostic description of narcissistic personality disorder (NPD) as it appears in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 5th edition, [ 1 ]) includes a lot of information about how the person affects others, such as requiring excessive admiration, having a sense of entitlement, interpersonal exploitativeness, showing both a lack of empathy for others and feeling others are envious of their perceived special powers or personality features. Despite these features being important aspects of narcissism that have been validated through empirical research [ 2 , 3 ], they have been criticised for their emphasis on grandiosity and the exclusion of vulnerability in narcissism [ 4 , 5 ], a trend that is mirrored in the field more generally and runs counter to over 35 years of clinical theory [ 3 ]. The more encompassing term ‘pathological narcissism’ has been used to better reflect personality dysfunction that is fundamentally narcissistic but allows for both grandiose and vulnerable aspects in its presentation [ 6 ].

Recognising the vulnerable dimension of narcissism has significant implications for treatment [ 7 ], including providing an accurate diagnosis and implementing appropriate technical interventions within treatment settings. Vulnerable narcissism, in marked contrast to the overt grandiose features listed in DSM-5 criteria, includes instances of depressed mood, insecurity, hypersensitivity, shame and identification with victimhood [ 8 , 9 , 10 , 11 , 12 ]. Pincus, Ansell [ 13 ] developed the Pathological Narcissism Inventory (PNI) to capture this narcissistic vulnerability in three factors. The factor ‘contingent self-esteem’ (item example: ‘It’s hard for me to feel good about myself unless I know other people like me’) reflects a need to use others in order to maintain self-esteem. The factor ‘devaluing’ includes both devaluation of others who do not provide admiration needs (‘sometimes I avoid people because I’m concerned that they’ll disappoint me’) and of the self, due to feelings of shameful dependency on others (‘when others disappoint me, I often get angry at myself’). The factor ‘hiding the self’ (‘when others get a glimpse of my needs, I feel anxious and ashamed’) reflects an unwillingness to show personal faults and needs. This factor may involve a literal physical withdrawal and isolation [ 14 ] but may also include a subtler emotional or psychic withdrawal due to feelings of inadequacy and shame which may result in the development of an imposter or inauthentic ‘false self’ [ 11 , 15 ], and which may also include a disavowal of emotions, becoming emotionally ‘empty’ or ‘cold’ [ 14 ]. Another aspect described in the literature are instances of ‘narcissistic rage’ [ 16 ] marked by hatred and envy in response to a narcissistic threat (i.e. threats to grandiose self-concept). Although commonly reported in case studies and clinical reports, it is unclear if it is a feature of only grandiose presentations or if it may more frequently present in vulnerable presentations [ 17 ].

While the differences in presentation between grandiose and vulnerable narcissism appear manifest, it has been argued that they reflect both sides of a narcissistic ‘coin’ [ 9 ] that may be regularly oscillating, inter-related and state dependent [ 6 , 18 , 19 , 20 , 21 , 22 ]. As such, it may not be as important to locate the specific presentation of an individual as to what ‘type’ they are (i.e. grandiose or vulnerable), as it is to recognise the presence of both of these aspects within the person [ 23 ]. The difficulty for these patients is the pain and distress that accompanies having such disparate ‘split off’ or unintegrated parts of the self, which result in the defensive use of maladaptive intra and interpersonal methods of maintaining a stable self-experience [ 24 ]. This defensive operation is somewhat successful, and may give the impression of a coherent and stable identity, however as noted by Caligor and Stern [ 25 ] “manifestly vulnerable narcissists retain a connection to their grandiosity … [and] even the most grandiose narcissist may have internal feelings of inadequacy or fraudulence” (p. 113).

The vulnerable dimension of narcissism, with its internal feelings of emptiness and emotion dysregulation, may reflect a more general personality pathology similar to that of borderline personality disorder (BPD) [ 26 ]. For instance, Euler, Stobi [ 27 ] found grandiose narcissism to be related to NPD, but vulnerable narcissism to be related to BPD. In a similar vein, Hörz-Sagstetter, Diamond [ 28 ] proposes grandiosity as a narcissistic ‘specific’ factor that distinguishes it from other disorders (e.g. BPD). This grandiosity, however, “ predisposes [these individuals] to respond with antagonism/hostility and reduced reality testing when the grandiose self is threatened ” (p.571). This antagonism, hostility and the resultant interpersonal dysfunction are well-documented aspects of pathological narcissism [ 29 , 30 , 31 , 32 ], that exacts a large toll on individuals in the relationship [ 33 , 34 ]. As the specific features of the disorder are perhaps therefore best evidenced within the context of these relationships, gaining the perspective of the ‘other’ in the relationship would present a unique perspective that may not be observable in other contexts (e.g. clinical or self-report research). For example, a recent study by Green and Charles [ 35 ] provided such a perspective within the context of domestic violence. They found that those in a relationship with individuals with reportedly narcissistic features described overt (e.g. verbal and physical) and covert (e.g. passive-aggressive and manipulative) expressions of abuse and that these behaviours were in response to perceived challenges to authority and to counteract fears of abandonment. As such, informant ratings may be a novel and valid methodology to assess for personality pathology [ 36 ], as documented discrepancies between self-other ratings suggest that individuals with pathological narcissism may not provide accurate self-descriptions [ 37 ]. Further, Lukowitsky and Pincus [ 38 ] report high levels of convergence for informant ratings of narcissism, indicating that multiple peers are likely to score the same individual similarly and, notably, individuals with pathological narcissism agreed with observer ratings of interpersonal dysfunction, again highlighting this aspect as central to the disorder [ 6 ]. The aim of this study is to investigate the reported characteristics of individuals with pathologically narcissistic traits from the perspective of those in a significant personal relationship with these individuals. For this research, partners and family members will be referred to as ‘participants’. Individuals with pathological narcissism will be referred to as the ‘relative’.

Recruitment

Participants were relatives of people reportedly high in narcissistic traits, and all provided written informed consent to allow their responses to be used in research, following institutional review board approval. The participants were recruited through invitations posted on various mental health websites that provide information and support that is narcissism specific (e.g. ‘Narcissistic Family Support Group’). Recruitment was advertised as being specifically in relation to a relative with narcissistic traits. A number of criteria were applied to ensure that included participants were appropriate to the research. First, participants had to identify as having a ‘significant personal relationship’ with their relative. Second, participants had to complete mandatory questions as part of the survey. Mandatory questions included basic demographic information (age, gender, relationship type) and answers to qualitative questions under investigation. Non-mandatory questions included questions such as certain demographic questions (e.g. occupation) and questions pertaining to their own support seeking. Third, the relative had to have a cumulative score of 36 (consistent with previous methodology, see [33]) or above on a narcissism screening measure (described in Measures section), as informed by participants.

Participants

A total of 2219 participants consented to participate in the survey. A conservative data screening procedure was implemented to ensure that participants were appropriate to the research. First, participants were removed who indicated that they did not have a ‘significant’ (i.e. intimate) personal relationship with someone who was narcissistic ( n  = 129). Second, participants who clicked on the link to begin the survey but dropped out within the first 1–5 questions were deemed ‘non-serious’ and were removed ( n  = 1006). Third, participants whose text sample was too brief (i.e. less than 70 words) to analyse were excluded ( n  = 399) as specified by Gottschalk, Winget [ 39 ]. Finally, participants identified as rating relatives narcissism below cut off score of 36 on a narcissism screening measure were removed ( n  = 249). Inspection of pattern of responses indicated that none of the remaining participants had filled out the survey questions inconsistently or inappropriately (e.g. scoring the same for all questions). The remaining 436 participants formed the sample reported here. Table  1 outlines the demographic information of participants and the relative included in the study.

Participants were also asked to report on the diagnosis that their relative had received. These diagnoses were specified as being delivered by a mental health professional and not the participants own speculation. The majority of participants either stated that their relative has not received a formal diagnosis, or that they did not know ( n  = 284, 65%). A total of 152 (35%) participants stated that their relative had received an official diagnosis from a mental health professional (See Table  2 ).

Pathological narcissism inventory (Carer version) (SB-PNI-CV)

Schoenleber, Roche [ 40 ] developed a short version of the Pathological Narcissism Inventory (SB-PNI; ‘super brief’) as a 12 item measure consisting of the 12 best performing items for the Grandiosity and Vulnerability composites (6 of each) of the Pathological Narcissism Inventory [ 13 ]. This measure was then adapted into a carer version (SB-PNI-CV) in the current research, consistent with previous methodology [ 33 ] by changing all self-referential terms (i.e. ‘I’) to refer to the relative (i.e. ‘my relative’). The scale operates on a Likert scale from 0 (‘not at all like my relative’) to 5 (‘very much like my relative’). By summing participant responses, a total score of 36 indicates that participants scored on average ‘a little like my relative’ to all questions, indicating the presence of pathologically narcissistic traits. The SB-PNI-CV demonstrated strong internal consistency (α = .80), using all available data ( N  = 1021). Subscales of the measure also demonstrated internal consistency for both grandiose (α = .73) and vulnerable (α = .75) items. Informant-based methods of investigating narcissism and its effects has previously been found to be effective and reliable [ 30 ] with consensus demonstrated across multiple observers [ 38 ].

Qualitative analyses

Participants who met inclusion criteria were asked to describe their relative using the Wynne-Gift speech sample procedure as outlined by Gift, Cole [ 41 ]. This methodology was developed for interpersonal analysis of the emotional atmosphere between individuals with severe mental illness and their relatives, it has also been used in the context of assessing relational functioning within marital couples [ 41 ]. For the purpose of this study, the speech sample prompt was used to elicit descriptive accounts of relational functioning, which included participants responding to the question:

‘What is your relative like, how do you get on together?’

Participants were given a textbox to respond to this question in as much detail as they would like. However, participants whose text responses were too brief (< 70 words), were removed from analysis as specified by Gottschalk, Winget [ 39 ]. It is important to note however that these participants who were removed ( n  = 399) did not differ from the included participants in any meaningful way regarding demographic information. The mean response length was 233 words (SD = 190) and text responses ranged from 70 to 1279 words.

Analysis of the data occurred in multiple stages. First, a phenomenological approach was adopted which places primacy on understanding the ‘lived experience’ of participant responses [ 42 ] whilst ‘bracketing’ researcher preconceptions. This involved reading and re-reading all participant responses in order to be immersed in the participants subjective world, highlighting text passages regarding the phenomenon under examination (i.e. personality features, descriptions of behaviour, etc) and noting comments and personal reactions to the text in the margins. This is done in an attempt to make the researchers preconceptions explicit, in order to attend as close as possible as to the content of what is being said by the participant. Second, codebook thematic analysis was used for data analysis as outlined by Braun, Clarke [ 43 ], which combines ‘top down’ and ‘bottom up’ approaches. Using this approach, a theory driven or ‘top down’ perspective was taken [ 44 ] in which researchers attempted to understand the reality of participants through their expressed content and within the context of the broader known features informed by the extensive prior work on the topic. In this way, the overarching themes of ‘grandiosity’ and ‘vulnerability’ were influenced by empirically determined features within the research literature (e.g. DSM-5 diagnostic criteria, factors within the PNI), however themes and nodes were free to be ‘split’ or merged organically during the coding process reflecting the ongoing conceptualisation of the data by the researchers. Significant statements were extracted and coded into nodes reflecting their content (e.g. ‘narcissistic rage’, ‘entitlement’) using Nvivo 11. This methodology of data analysis via phenomenologically analysing and grouping themes is a well-documented and regularly utilized qualitative approach (e.g. [ 45 , 46 ]). Once data analysis had been completed the second author completed coding for inter-rater reliability analysis on 10% of data. The second rater was included early in the coding process and the two reviewers meet on several occasions to discuss the nodes that were included and those that were emerging from the data. 10% of the data was randomly selected by participant ID numbers. At the end of this process, it was then confirmed that the representation of the data also reflected the participant relationships (i.e. marital partner, child etc). Cohen’s Kappa coefficient was used to index inter-rater reliability by calculating the similarity of nodes identified by the two researchers. This method takes into consideration the agreement between the researchers (observed agreement) and compares it to how much agreement would be expected by chance alone (chance agreement). Inter-rater reliability for the whole dataset was calculated as κ = 0.81 which reflects a very high level of agreement between researchers that is not due to chance alone [ 47 ].

Cluster analysis

A cluster analysis dendrogram was generated using Nvivo 11 for purposes of visualisation and to explore the underlying dimensions of the data [ 48 ]. This dendrogram displays the measure of similarity between nodes as coded, in which each source (i.e. participant response) is coded by each node. If the source is coded by the node it is listed as ‘1’ and ‘0’ if it is not. Jaccard’s coefficient was used to calculate a similarity index between each pair of items and these items were grouped into clusters using the complete linkage hierarchical clustering algorithm [ 49 ].

Two broad overarching dimensions were identified. The first dimension, titled ‘grandiosity’, included descriptions that were related to an actual or desired view of the self that was unrealistically affirmative, strong or superior. The second dimensions, titled ‘vulnerability’, included an actual or feared view of the self that was weak, empty or insecure. Beyond these two overarching dimensions, salient personality features not accounted for by the ‘grandiose’ or ‘vulnerable’ dimensions were included within a category reflecting ‘other personality features’. Themes not relating specifically to personality style, but that may provide insights regarding character formation or expression were included within the category of ‘descriptive themes’.

A total of 1098 node expressions were coded from participant responses ( n  = 436), with a total of 2182 references. This means participant responses were coded with an average of two to three individual node expressions (e.g. ‘hiding the self’, ‘entitlement’) and there were on average 5 expressions of each node(s) in the text.

Overarching dimension #1: grandiosity

Participants described the characterological grandiosity of their relative. This theme was made up of ten nodes: ‘Requiring Admiration’, ‘Arrogance’, ‘Entitlement’, ‘Envy’, ‘Exploitation’, ‘Grandiose Fantasy’, ‘Grandiose Self Importance’, ‘Lack of Empathy’, ‘Belief in own Specialness’ and ‘Charming’.

Node #1: requiring admiration or attention seeking

Participants described their relative as requiring excessive admiration. For instance, “He puts on a show for people who can feed his self-image. Constantly seeking praise and accolades for any good thing he does” (#1256); “He needs constant and complete attention and needs to be in charge of everything even though he expects everyone else to do all the work” (#1303).

Node #2: arrogance

Relatives were described as often displaying arrogant or haughty behaviours or attitudes. For instance, “ He appears to not be concerned what other people think, as though he is just ‘right’ and ‘superior’ about everything” (#1476) and “My mother is very critical towards everyone around her... family, friends, neighbours, total strangers passing by... everybody is ‘stupid’” (#2126).

Node #3: entitlement

Relatives were also described as having a sense of entitlement. For example, “I paid all of the bills. He spent his on partying, then tried to tell me what to do with my money. He took my bank card, without permission, constantly. Said he was entitled to it” (#1787) and “He won’t pay taxes because he thinks they are a sham and he shouldn’t have to just because other people pay” (#380).

Node #4: envy and jealousy

Participants described instances of their relative being envious or jealous of others. Jealousy, being in relation to the threatened loss of important relationships, was described by participants. For instance, after describing the abusive behaviours of their relative one participant stated “It got worse after our first son was born, because he was no longer the centre of my attention. I actually think he was jealous of the bond that my son and I had” (#1419). Other participants, despite using the term ‘jealous’, described more envious feelings in their relative relating to anger in response to recognising desirable qualities or possessions of others. For instance, another participant stated “[they have] resentment for people who are happy, seeing anyone happy or doing great things with their life makes them jealous and angry” (#1744). Some participants described their relative believing that others are envious of them, for example “ [ he] thought everyone was jealous he had money and good looks.” (#979) and “[he] tried to convince everyone that people were just jealous of him because he had a nice truck” (#1149).

Node #5 exploitation

Relatives were described as being interpersonally exploitative (i.e. taking advantage of others). For instance, one participant stated “He brags how much he knows and will take someone else’s knowledge and say he knew that or claim it’s his idea” (#1293). Another participant stated “ With two other siblings that are disabled, she uses funding for their disabilities to her advantage … I do not think she cares much for their quality of life, or she would use those funds for its intended use.” (#998).

Node #6 grandiose fantasy

Participants also described their relatives as engaging in unrealistic fantasies of success, power and brilliance. For instance, the response “He believes that he will become a famous film screen writer and producer although he has no education in film” (#1002); “He was extremely protective of me, jealous and woefully insecure. [He] went on ‘missions’ where he was sure [world war three] was about to start and he was going to save us, he really believes this” (#1230).

Node #7 grandiose self importance

Relatives were described as having a grandiose sense of self-importance (e.g. exaggerating achievements, expecting to be recognised as superior without commensurate achievements). Examples of this include “He thinks he knows everything … conversations turn into an opportunity for him to ‘educate’ me” (#1046); “ He tells endless lies and elaborate stories about his past and the things he has achieved, anyone who points out inconsistencies in his stories is cut out of his lif e” (#178).

Node #8 compromised empathic ability

Participants described their relatives as being unwilling to empathise with the feelings or perspectives of others. Some examples include “she has never once apologized for her abuse, and she acts as if it never happened. I have no idea how she can compartmentalize like that. There is no remorse” (#1099) and “[he] is incapable of caring for all the needs of his children because he cannot think beyond his own needs and wants, to the point of his neglect [resulting in] harm to the children” (#1488).

Node #9 belief in own specialness

Relatives were described as believing they were somehow ‘special’ and unique. For example, one participant described their relative as fixated with their status as an “important [member] of the community” (#860), another participant stated “he considers himself a cut above everyone and everything... Anyone who doesn’t see him as exceptional will suffer” (#449). Other responses indicated their relatives were preoccupied with being associated with other high status or ‘special’ people. For instance, one participant stated that their relative “likes to brag about how she knows wealthy people as if that makes her a better person” (#318) and another stating that their relative “loves to name drop” (#49).

Node #10 charming

Participants also described their relative in various positive ways which reflected their relatives’ likeability or charm. For instance, “He is fun-loving and generous in public. He is charming and highly intelligent” (#1401); “His public persona, and even with extended family, is very outgoing, funny and helpful. Was beloved by [others]” (#1046) and “He is very intelligent and driven, a highly successful individual. Very social and personable and charming in public, funny, the life of the party” (#1800).

Overarching dimension #2: vulnerability

Participants described the characterological vulnerability of their relative. This theme was made up of nine nodes: ‘Contingent Self Esteem’, ‘Devaluing’, ‘Emotionally Empty or Cold’, ‘Hiding the Self’, ‘Hypersensitive’, ‘Insecurity’, ‘Rage’, ‘Affective Instability’ and ‘Victim Mentality’.

Node #1 contingent self esteem

Participants described their relatives as being reliant on others approval in order to determine their self-worth. For instance, “She only ever seems to be ‘up’ when things are going well or if the attention is on her” (#1196) and “He appears to be very confident, but must have compliments and reassuring statements and what not, several times a day” (#1910).

Node #2 devaluing

Relatives were described as ‘putting down’ or devaluing others in various ways and generally displaying dismissive or aggressive behaviours. For instance, “On more than one occasion, he’s told me that I’m a worthless person and I should kill myself because nobody would care” (#1078) and “He feels intellectually superior to everyone and is constantly calling people idiotic, moron, whatever the insult of the day is” (#1681).

Relatives were also described as reacting to interpersonal disappointment with shame and self-recrimination, devaluing the self. For instance, “They are extremely [grandiose] … [but] when someone has the confidence to stand up against them they crumble into a sobbing mess wondering why it’s always their fault” (#1744) and “I have recently started to stand up for myself a little more at which point he will then start saying all the bad things are his fault and begging forgiveness” (#274).

Node #3 emotionally empty or cold

Participants described regularly having difficulty ‘connecting’ emotionally with their relative. For instance, one participant described that their relative was “largely sexually disengaged, unable to connect, difficulty with eye contact … he used to speak of feeling dead” (#1365); another stated “he was void of just any emotion. There was nothing. In a situation of distress he just never had any feeling. He was totally void of any warmth or feeling” (#323), another stated “I gave him everything. It was like pouring myself into an emotional black hole” (#627).

Node #4 hiding the self

Participants reported instances in which their relative would not allow themselves to be ‘seen’, either psychologically or physically. One way in which they described this was through the construction of a ‘false self’. For instance “He comes across very confident yet is very childish and insecure but covers his insecurities with bullish and intimidating behaviour” (#2109). Another way participants described this hiding of self was through a literal physical withdrawal and isolation. For example, “He will also have episodes of deep depression where he shuts himself off from human contact. He will hide in his room or disappear in his sleeper semi-truck for days with no regard for his family or employer” (#1458).

Node #5 hypersensitive

Participants reported feeling as though they were ‘walking on eggshells’ as their relative would respond volatilely to perceived attacks. For instance, “She cannot take advice or criticism from others and becomes very defensive and abusive if challenged” (#1485); “It was an endless mine field of eggshells. A word, an expression would be taken against me” (#532) and “Very irrational and volatile. Anything can set her off on a rage especially if she doesn’t get her way” (#822).

Node #6 insecurity

Relatives were described as having an underlying sense of insecurity or vulnerability. For instance “He really is just a scared little kid inside of a big strong man’s body. He got stuck when he was a child” (#1481); “At the core he feels unworthy, like a fake and so pretty much all introspection and self-growth is avoided at all costs” (#532) and “At night when the business clothes come off his fears eat him up and he would feel highly vulnerable and needs lots of reassurance” (#699).

Node #7 rage

Participants reported that their relatives were particularly prone to displaying explosive bouts of uncontrolled rage. For example, “He has a very fragile ego … he will fly off the handle and subject his target to hours of screaming, insults and tantrum-throwing” (#1078); “he has a temper tantrum-like rage that is frightening and dangerous” (#1476); “He has hit me once. Left bruises on upper arms and back. He goes into rage and has hit walls, hits himself” (#1637).

Node #8 affective instability (symptom patterns)

Relatives were also described as displaying affective instability which may be related to anxiety and depressive disorders. Relatives were commonly described as being ‘anxious’ (#1091) including instances of hypochondria (#1525), agoraphobia (#756), panic (#699) and obsessive compulsive disorder (#2125). Relatives were also commonly described as having episodes of ‘depression’ (#1106) and depressive symptoms such as low mood (#1931), problems sleeping (#1372). Some participants also described their relative as highly suicidal, with suicidality being linked to relationship breakdowns or threats to self-image. For example, “When I state I can’t take any more or say we can’t be together … he threatens to kill himself” (#1798); “If he feels he is being criticised or blamed for something (real or imagined) … his attacks become self-destructive” (#1800).

Node #9 victim mentality

Participants reported that their relatives often described feeling as though they were the victim of attacks from others or taken advantage of in some way. For instance, “He seems to think that he has been ‘hard done by’ because after all he does for everyone, they don’t appreciate him as much as they should” (#1476); “He will fabricate or twist things that are said so that he is either the hero or the victim in a situation” (#447).

Other personality features

Participants also reported some descriptions of their relative that were not described within prior conceptualisations of narcissism. This theme was made up of 3 nodes: ‘Perfectionism’, ‘Vengeful’ and ‘Suspicious’.

Node #1 perfectionism

Participants repeatedly described their relative displaying perfectionistic or unrelenting high standards for others. For instance, “I cannot just do anything at home everything I do is not to her standard and perfection ” (#1586) and “Everything has to be done her way or it’s wrong and she will put you down. She has complete control over everything” (#1101).

Node #2 vengeful

Participants described their relative as being highly motivated by revenge and displaying vindictive punishing behaviours against others. Examples include, “[He] has expressed thoughts of wanting to hurt those who cause him problems” (#230); “He is degrading to and about anyone who doesn’t agree with him and he is very vengeful to those who refuse to conform to his desires” (#600) and “Once someone crosses him or he doesn’t get his way, he becomes vindictive and will destroy their life and property and may become physically abusive” (#707).

Node #3 suspicious

Participants described their relative as holding paranoid or suspicious beliefs about others intentions or behaviours. For instance, “He would start fights in public places with people because he would claim they were ‘looking at him and mimicking him’” (#1149) and “She is angry most days, obsessively talking about who wronged her in the past, currently or who probably will in the future” (#2116).

Descriptive themes

Several salient descriptive themes were also coded from the data that, while not relating directly to the relatives character, may provide peripheral or contextual information.

Descriptive theme #1: trauma

A number of participants described their relative as having experienced a traumatic or troubled childhood. One participant stated that their relatives’ father “was extraordinarily abusive both emotionally and physically to both him and the mother … [the father] pushed [the relative] as a young boy on prostitutes as a 12th birthday gift … He was beaten on and off from age 6 to 15 when he got tall enough to threaten back” (#1249). Another participant described the emotional upbringing of their relative “[his mother was] prone to being easily offended, fighting with him and cutting off all contact except to tell him what a rotten son he was, for months, then suddenly talking again to him as if nothing had ever happened. His father, he said, was strict and expected a lot of him. Both rarely praised him; whenever he accomplished something they would just demand better instead of congratulating him on his accomplishment” (#1909). Another participant reflected on how their relative’s upbringing may be related to their current emotional functioning, “personally I think he is so wounded (emotional, physical abuse and neglect) that he had to detach from himself and others so much just to survive” (#1640).

Descriptive theme #2: excessive religiosity

While participant’s comments on their relative’s religiosity were common, the content was varied. Some participants described their relative using religion as a mechanism to control, for instance “he uses religion in an extremely malignant way. Manipulating verses and religious sayings and interpret them according to his own will” (#132) and “very religious. She uses scripture to manipulate people into doing what she wants on a regular basis” (#1700). One participant described how their relative’s religiosity became infused with their grandiose fantasy “He has also gone completely sideways into fundamental religious doctrine, as if he knows more than the average ‘Christian’ about End Times, and all kinds of illuminati type conspiracy around that topic. He says God talks to him directly and tells him things and that he has had dead people talk to him” (#1476). Other participants described how their relative’s religiosity was merely an aspect of their ‘false self’, for example “she has a wonderful, loving, spiritual facade that she shows to the world” (#1073).

Descriptive theme #3: substance use

Participants regularly described their relative as engaging in substance use. Substances most frequently named were alcohol, marijuana, cocaine and ‘pills’. Participants reported that when their relative was using substances their behaviour often became dangerous, usually through drink driving, one participant stated “too much alcohol … he would drive back to [his work] … I was always afraid of [a driving accident]” (#76).

Subtype expression

Of 436 participants, a total of 348 unique grandiose node expressions were present and a total of 374 unique vulnerable node expressions were present. Of these, 301 participants included both grandiose and vulnerable descriptions of their relative (69% of sample). Only 47 (11% of sample) focused on grandiose features in their description of their relative, and only 88 participants (20% of sample) focused on vulnerable features.

A cluster analysis dendrogram was generated using Nvivo 11 for purposes of visualising and exploring the underlying dimensions of the data [ 48 ] and is displayed in Fig.  1 . Four clusters of nodes and one standalone node can be distinguished. The first cluster, labelled ‘Fantasy Proneness’, includes nodes reflecting the predominance of ‘fantasy’ colouring an individuals interactions, either intrapersonally (‘grandiose self-importance, belief in specialness’) or interpersonally (‘suspicious, envy’). The second cluster, labelled ‘Negative Other’, reflects nodes concerned with a detached connection with others (‘emotionally empty’) and fostering ‘vengeful’ and ‘exploitative’ drives towards others, as well as feelings of victimhood. Interestingly, despite being related to these other aspects of narcissism, ‘perfectionism’ was factored as reflecting its own cluster, labelled ‘Controlling’. The fourth cluster, labelled ‘Fragile Self’, includes nodes indicating feelings of vulnerability (‘affective instability’, ‘insecurity’) and shameful avoidance (‘hiding the self’, ‘false self’, ‘withdrawal’) due to these painful states. The fifth cluster, labelled ‘Grandiose’ reflects a need (‘contingent self-esteem’, ‘requiring admiration’) or expectation (‘entitlement’, ‘arrogance’) of receiving a certain level of treatment from others. It also includes nodes regarding how individuals foster this treatment (‘charming’, ‘rage’, and ‘devaluing’) and a hypervigilance for if their expectations are being met (‘hypersensitive’).

Cluster analysis of nodes based on coding similarity. Note. Clusters are labelled as follows: 1. Fantasy Proneness, 2. Negative Other, 3. Controlling, 4. Fragile Self, 5. Grandiose

This study aimed to qualitatively describe the interpersonal features of individuals with traits of pathological narcissism from the perspective of those in a close relationship with them.

Grandiose narcissism

We found many grandiose features that have been validated through empirical research [ 2 , 3 , 19 ]. Grandiosity, as reflected in the DSM-5, has been argued to be a key feature of pathological narcissism that distinguishes it from other disorders [ 26 , 28 ]. One feature regularly endorsed by participants that is not encompassed in DSM-5 criteria is relatives’ level of interpersonal charm and likability. This charm as described by participants appears more adaptive than a ‘superficial charm’ that might be more exclusively ‘interpersonally exploitative’ in nature. However, it should be noted that this charm did not appear to persist, and was most often described as occurring mainly in the initial stages of a relationship or under specific circumstances (e.g. in public with an audience).

Vulnerable narcissism

We also found participants described their relative in ways consistent with the vulnerable dimensions of the pathological narcissism inventory (i.e. hiding the self, contingent self esteem and devaluing [ 50 ];). Dimensions that are also included in other popular measures for vulnerable narcissism were also endorsed by participants in our sample. For instance, the nodes of ‘hypersensitivity’, ‘insecurity’ and ‘affective instability’ reflect dimensions covered in the Hypersensitive Narcissism Scale [ 51 ] and neuroticism within the Five Factor Narcissism Inventory [ 52 ]. These aspects of narcissism have also been documented within published literature [ 12 , 27 , 53 , 54 ].

Subtype expression: cluster analysis

Most participants (69% of sample) described both grandiose and vulnerable characteristics in their relative, which given the relatively small amount of text and node expressions provided per participant is particularly salient. Given the nature of the relationship types typically endorsed by participants (i.e. romantic partner, family member), it suggests that the degree of observational data on their relative is quite high. As such, these results support the notion that an individual’s narcissism presentation may fluctuate over time [ 20 , 21 ] and that vulnerable and grandiose presentations are inter-related and oscillating [ 9 , 19 ].

The cluster analysis indicates the degree to which salient co-occurring features were coded. These features can be grouped to resemble narcissistic subtypes as described in research literature, such as the subtypes outlined by Russ, Shedler [ 55 ] in their Q-Factor Analysis of SWAP-II Descriptions of Patients with Narcissistic Personality Disorder. Our clusters #1–3 (‘Fantasy Proneness’, ‘Negative Other’ and ‘Controlling’) appear to resemble the ‘Grandiose/malignant narcissist’ subtype as described by the authors. This subtype includes instances of self-importance, entitlement, lack of empathy, feelings of victimisation, exploitativeness, a tendency to be controlling and grudge holding. Our cluster #4–5 (‘Fragile Self’ and ‘Grandiose’) appear to resemble the ‘Fragile narcissist’ subtype described including instances of depressed mood, internal emptiness, lack of relationships, entitlement, anger or hostility towards others and hypersensitivity towards criticism. Finally, our ‘Grandiose’ cluster (#5) showed overlap with the ‘high functioning/exhibitionistic narcissist’ subtype, which displays entitled self-importance but also a significant degree of interpersonal effectiveness. We found descriptions of the relative showing ‘entitlement’, being ‘charming’ and ‘requiring admiration’.

While co-occurring grandiose and vulnerable features are described at all levels of clusters in our sample, distinctions between the observed clusters may be best understood as variations in level of functioning, insight and adaptiveness of defences. As such, pathological narcissism has been understood as a characterological way of understanding the self and others in which feelings of vulnerability are defended against through grandiosity [ 56 ], and threats to grandiosity trigger dysregulating and disintegrating feelings of vulnerability [ 53 ]. Recent research supports this defensive function of grandiosity, with Kaufman, Weiss [ 11 ] stating “ grandiose narcissism was less consistently and strongly related to psychopathology … and even showed positive correlations with adaptive coping, life satisfaction and image-distorting defense mechanisms ” (p. 18). Similarly, Hörz-Sagstetter, Diamond [ 28 ] state ‘high levels of grandiosity may have a stabilizing function’ on psychopathology (p. 569). This defence, however, comes at a high cost, whether it be to the self when the defensive grandiosity fails (triggering disintegrating bouts of vulnerability) or to others, as this style of relating exacts a high toll on those in interpersonal relationships [ 33 ].

Participants described their relative as highly perfectionistic, however the perfectionism described was less anxiously self-critical and more ‘other oriented’. This style of other oriented ‘narcissistic perfectionism’ has been documented by others [ 57 ] and appears not to have the hallmarks of overt shameful self-criticism at a surface level, however may still exist in covert form [ 58 ]. Regarding the ‘vengeful’ node, Kernberg [ 16 ], Kernberg [ 59 ] describes that as a result of a pain-rage-hatred cycle, justification of revenge against the frustrating object is an almost unavoidable consequence. Extreme expressions of acting out these “ego-syntonic” revenge fantasies may also highlight the presence of an extreme form of pathological narcissism in this sample – malignant narcissism, which involves the presence of a narcissistic personality with prominent paranoia and antisocial features [ 60 ]. Lastly, Joiner, Petty [ 61 ] report that depressive symptoms in narcissistic personalities may evoke paranoid attitudes, which may in turn be demonstrated in the behaviours and attitudes expressed in the ‘suspicious’ node we found.

While this study focused on a narcissistic presentation, the presence in this sample of these other personality features (which could alternatively be described as ‘anankastic’, ‘antisocial’ and ‘paranoid’) is informed by the current conversation regarding dimensional versus categorical approaches [ 62 , 63 ]. Personality dysfunction from a dimensional perspective, such as in the ‘borderline personality organisation’ [ 23 ] or borderline ‘pattern’ [ 64 ] could understand these co-occurring personality features as not necessarily aspects of narcissism or ‘co-morbidities’, but as an individual’s varied pattern of responding that exists alongside their more narcissistic functioning, reflecting a more general level of disorganisation that resists categorisation. This is particularly reflected in Table 2 as participants reported a wide variety of diagnosed conditions, as well as the ‘Affective Instability’ node which may reflect various diagnostic symptom patterns.

Descriptive features

The relationship between trauma and narcissism has been documented [ 58 , 65 , 66 , 67 ] and the term ‘trauma-associated narcissistic symptoms’ has been proposed to identify such features [ 68 ]. Interestingly, while participants in our sample did describe instances of overt abuse which were traumatic to their relative (e.g. physical, verbal, sexual), participants also described hostile environments in which maltreatment was emotionally abusive or manipulative in nature, as well as situations where there was no overt traumatic abuse present but which most closely resemble ‘traumatic empathic failures’. This type of attachment trauma, stemming from emotionally invalidating environments, is central to Kohut’s theory of narcissistic development [ 69 , 70 ], and has found support in recent research [ 71 ]. Relatives religiosity was noteworthy, not necessarily due to its presence, but due to the narcissistic function that the religiosity served. Research on narcissism and religious spirituality has steadily accumulated over the years (for a review see: [ 72 ]) and the term ‘spiritual bypassing’ [ 73 ] is used for individuals who use religion in the service of a narcissistic defence. In our sample this occurred via alignment with an ‘ultimate authority’ in order to bolter esteem and control needs. It may be that the construction of a ‘false self’ rooted in spirituality is conferred by the praise and audience of a community of believers. Finally, participants reported their relative as engaging in various forms of substance use, consistent with prevalence data indicating high co-occurrence of narcissism and substance use [ 65 ]. While the motivation behind relatives substance use was not mentioned by participants, it is consistent with relatives more general use of reality distorting defences, albeit a more physicalised as opposed to an intrapsychic method.

Implications of findings

First, this study extends and supports the widespread acknowledged limitation of DSM-5 criteria for narcissistic personality disorder regarding the exclusion of vulnerable features (for a review of changes to dignostic criteria over time, see [ 74 , 75 ]) and we acknowledge the current discussion regarding therapist decision to provide a diagnosis of NPD [ 76 ]. However, the proliferation of alternate diagnostic labels may inform conceptualisations which do not account for the full panorama of an individual’s identity [ 7 ], adding to the already contradictory and unintegrated self-experience for individuals with a narcissistic personality. This may also impede the treatment process by informing technical interventions which may be contra-indicated. For instance, treatment of individuals with depressive disorders require different approaches than individuals with a vulnerably narcissistic presentation [ 24 , 77 ]. As such, a focus of treatment would include the integration of these disparate self-experiences, through the exploration of an individual’s affect, identity and relationships, consistent with the treatment of personality disorders more generally. Specifically, when working with an individual with a narcissistic personality, this may involve identifying and clarifying instances of intense affect, such as aggression and envy, themes of grandiosity and vulnerability in the self-concept, and patterns of idealization and devaluation in the wider relationships. The clinician will need to clarify, confront or interpret to these themes and patterns, their contradictory nature as extreme polarities, and attend to the oscillation or role reversals as they appear [ 78 ]. Second, as the characterological themes identified in this paper emerged within the context of interpersonal relationships, this highlights the interconnection between impaired self and other functioning. As such, in the context of treating an individual with pathological narcissism, discussing their interpersonal relationships may be a meaningful avenue for exploring their related difficulties with identity and emotion regulation that may otherwise be difficult to access. This is particularly salient as treatment dropout is particularly high for individuals with pathological narcissism [ 4 ], and as typical reason for attending treatment is for interpersonal difficulties [ 79 ]. Third, treatment for individuals with narcissistic personalities can inspire intense countertransference responses in clinicians [ 80 ] and often result in stigmatisation [ 81 ]. As such, these findings also provide a meaningful way for the clinician to extend empathy to these clients as they reflect on the defensive nature of the grandiose presentation, the distressing internal emptiness and insecurity for these individuals, and the potential childhood environment of emotional, sexual or physical trauma and neglect which may have informed this defensive self-organisation. Finally, these findings would also directly apply to clinicians and couples counsellors working with individuals who identify their relative as having significant narcissistic traits, providing them with a way to understand the common ways these difficulties express themselves in their relationships and the impact they may have on the individuals in the relationship. Practically, these findings may inform a heightened need for treating clinicians to assess for interpersonal violence and the safety of clients in a context of potential affective dysregulation and intense aggression. Regarding technical interventions, if working with only one of the individuals in the relationship, these findings may provide avenues for psychoeducation regarding their relatives difficulties with identity and affect regulation, helping them understand the observed oscillating and contradictory self-states of their relative. If working with both individuals or the couple, the treating clinician will need to be able to identify and interpret changes in affect and identity, and the way this manifest in the relationship functioning of the couple and their characteristic ways of responding to each other (e.g. patterns of idealization and devaluation). This may also involve attending to the ways in which the therapist may be drawn into the relationship with the couple, noticing and interpreting efforts at triangulation or any pressure to ‘pick sides’ from either individual.

Limitations

The sample selection procedure may have led to results only being true for some, but not all people living with a relative with narcissistic features. Participants were recruited online limiting the opportunity to understand participant motivation. Second, relying on informant ratings of narcissism for both screening and qualitative analysis is a limitation as we are less unable to control for severity, specificity or accuracy of participant reporting. Further, it is possible that the use of a narcissism screening tool primed participants to artificially report on particular aspects of their relative. However, the risk of biasing or priming participants is a limitation of all studies of this kind, as studies implementing informant methodology for assessing narcissism typically rely on providing participants with a set of diagnostic criteria or narcissism specific measures as their sole indicator of narcissism (e.g. [ 30 , 38 ]). As such, notwithstanding the limitations outlined, this informs the novelty and potential utility of the present approach which relies on identifying narcissism specific features amongst a backdrop of descriptions of more general functioning within intimate relationships. Third, gender disparity in participants and relatives was substantial. However, as NPD is diagnosed more commonly in males (50–75%, American Psychiatric Association, 2013) and as most participants in our sample were in a romantic, heterosexual relationship, this disparity may reflect a representative NPD sample and should not significantly affect the validity of results. Rather, this disparity may strengthen the argument that individuals with a diagnosis of NPD (as specified by DSM-5 criteria) may have co-occurring vulnerable features, which may not be currently reflected in diagnostic categories. Finally, as a result of relying on informant ratings and not assessing narcissistic individuals via structured clinical interview, questions regarding the specificity and severity of the narcissistic sample are unable to be separated in the analysis. We thus probably studied those ranging from ‘adaptive’ or high functioning narcissism [ 82 ] to more severe and disabling character disorders. Whilst we screened for narcissistic features, it was clear the sample studied also reported a broad range of other co-occurring problems.

We investigated the characteristics of individuals with pathologically narcissistic traits from the perspective of those in a significant personal relationship with them. The overarching theme of ‘Grandiosity’ involved participants describing their relative as requiring admiration, displaying arrogant, entitled, envious and exploitative behaviours, engaging in grandiose fantasy, lacking in empathy, having a grandiose sense of self-importance, believing in own sense of ‘specialness’ and being interpersonally charming. The overarching theme of ‘Vulnerability’ involved participants describing their relative’s self-esteem being contingent on others, as being hypersensitive, insecure, displaying affective instability, feelings of emptiness and rage, devaluing self and others, hiding the self through various means and viewing the self as a victim. Relatives were also described as displaying perfectionistic, vengeful and suspicious personality features. Finally, participants also described several descriptive themes, these included the relative having a trauma history, religiosity in the relative and the relative engaging in substance use. The vulnerability themes point to the problems in the relatives sense of self, whilst the grandiose themes show how these express themselves interpersonally. The complexity of interpersonal dysfunction displayed here also points to the importance of assessing all personality traits more broadly.

Availability of data and materials

The datasets generated during and/or analysed during the current study are not publicly available due to the sensitive and personal nature of participant responses but are available from the corresponding author on reasonable request.

Change history

22 january 2022.

A Correction to this paper has been published: https://doi.org/10.1186/s40479-022-00177-x

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Me, me, me! How narcissism changes throughout life

For parents worried that their teenager's narcissism is out of control, there's hope. New research from Michigan State University conducted the longest study on narcissism to date, revealing how it changes over time.

"There's a narrative in our culture that generations are getting more and more narcissistic, but no one has ever looked at it throughout generations or how it varies with age at the same time," said William Chopik, associate professor of psychology at MSU and lead author.

The research, published in Psychology and Aging , assessed a sample of nearly 750 people to see how narcissism changed from age 13 to 70. The findings showed that qualities associated with narcissism -- being full of yourself, sensitive to criticism and imposing your opinion on others -- decline over time and with age. Some character traits -- like having high aspirations for yourself -- increased with age.

"There are things that happen in life that can shake people a little bit and force them to adapt their narcissistic qualities," Chopik said. "As you age, you form new relationships, have new experiences, start a family and so on. All of these factors make someone realize that it's not 'all about them.' And, the older you get, the more you think about the world that you may leave behind."

The greatest impetus for declining narcissism, Chopik said, was landing a first job.

"One thing about narcissists is that they're not open to criticism. When life happens and you're forced to accept feedback, break up with someone or have tragedy strike, you might need to adjust to understanding that you're not as awesome as you once thought," Chopik said. "There's a sense in which narcissists start to realize that being the way they are isn't smart if they want to have friends or meaningful relationships."

Chopik found that the fastest-changing age group was young adults. He also found that, contrary to popular belief, changes in the levels of narcissism are lifelong and changes don't stop at any certain age or stage in life.

"One of the most surprising findings was that -- also contrary to what many people think -- individuals who were born earlier in the century started off with higher levels of hyper-sensitivity, or the type of narcissism where people are full of themselves, as well as willfulness, which is the tendency to impose opinions on others," Chopik said. "There isn't much data on older generations, but now that Baby Boomers are aging into that phase of life, it's a huge part of the population that we need to be looking at."

With these his findings, the researchers hope that the public gains a greater understanding about the different types of narcissism as well as new insight to the understudied older populations. Also, if you're worried that someone is truly a narcissist, there's hope they will change for the better as they get older, Chopik added.

• Anger Management
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• William J. Chopik, Kevin J. Grimm. Longitudinal changes and historic differences in narcissism from adolescence to older adulthood. . Psychology and Aging , 2019; 34 (8): 1109 DOI: 10.1037/pag0000379

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• Published: 24 May 2024

How does narcissistic leadership influence change-oriented organizational citizenship behavior? Empirical evidence from China

• Yangchun Fang 1 , 2 ,
• Yonghua Liu 1 ,
• Peiling Yu 1 &
• Nuo Chen 1  

Humanities and Social Sciences Communications volume  11 , Article number:  667 ( 2024 ) Cite this article

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• Business and management

Based on conservation of resources theory and the work–home resources model, this study examines how and when narcissistic leadership influences employees’ change-oriented organizational citizenship behavior. A total of 363 employees from 61 teams across numerous enterprises based in central China were surveyed using a questionnaire. The study hypotheses were tested using structural equation modeling and Monte Carlo simulation analysis. The findings revealed that narcissistic leadership results in the development of a negative team climate, termed “team chaxu climate,” which, in turn, hinders employees’ change-oriented organizational citizenship behavior. Furthermore, this study explored the moderating role of leaders’ family affective support in the relationship between narcissistic leadership and team chaxu climate. This study contributes to our understanding of the relationship between narcissistic leadership and employee organizational citizenship behavior and empirically validates the work–home resources model.

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Introduction.

Recent studies have reported that narcissistic leaders are becoming increasingly common worldwide; the media have characterized prominent business leaders—such as Steve Jobs, Elon Musk, and Jack Welch—as narcissists (Visser et al. 2017 ). Incumbent leaders have the authority to allocate organizational resources and a strong sense of superiority when dealing with subordinates (Morf and Rhodewalt 2001b ; Rosenthal and Pittinsky 2006 ). Meanwhile, narcissists—typically self-assured, expressive, and inclined to exaggerate their strengths—tend to receive higher leadership ratings and are more likely to distinguish themselves and become leaders than non-narcissists (Brunell et al. 2008 ; Gauglitz et al. 2023 ). However, narcissists are extremely egocentric and arrogant, frequently acting for personal benefit, insensitive to others’ needs and recommendations, and challenging to form a healthy connection with (Hogan et al. 1990 ; Paulhus 1998 ). Narcissistic leadership generally precipitates unfavorable organizational outcomes (Ouimet 2010 ; Rosenthal and Pittinsky 2006 ), particularly by weakening employees’ organizational citizenship behavior (OCB). For example, Li and Zhang ( 2018 ) found that narcissistic leadership behaviors elevate employee hindrance stress and negatively impact employees’ OCB. Ha et al. ( 2020 ) demonstrated that narcissistic leaders disrupt the principle of reciprocity between leaders and employees, thereby suppressing employees’ OCB. Similarly, Wang et al. ( 2021 ) reported that narcissistic leaders undermine employees’ psychological safety and affective organizational commitment, thus decreasing the latter’s OCB. By contrast, some studies have found that narcissistic leaders also promote employees’ OCB. Narcissistic leaders enhance employees’ OCB by providing them with greater autonomy (Zhang et al. 2017 ) and encouraging them to freely express their opinions regarding current organizational issues (Zhang et al. 2022 ). Additionally, Zhu et al. ( 2023 ) found that subordinates engage in OCB because they admire narcissistic leaders. These divergent findings indicate that the relationship between narcissistic leadership and employee OCB is complex and that our understanding of narcissistic leadership is limited and requires further in-depth research. Specifically, recent research has reported that narcissistic leaders engage in behaviors that deviate from their narcissistic traits—such as developing satisfactory relationships with subordinates and involving them in significant decision-making (Carnevale et al. 2018 ; Owens et al. 2015 ). This finding is inconsistent with the previous one that narcissistic leaders cannot develop satisfactory relationships with their subordinates (de Vries and Miller 1985 ; Rosenthal and Pittinsky 2006 ). Notably, narcissistic leaders—instead of developing satisfactory relationships with all team members—befriend only some members and alienate others (Huang et al. 2020 ). However, why narcissistic leaders engage in such behaviors remains unclear.

To ascertain why narcissistic leaders exhibit this deviant behavior and how and when narcissistic leadership influences employees’ OCB, we constructed a moderated mediation model based on conservation of resources (COR) theory and the Work–Home Resources (W–HR) model. We argue that narcissistic leadership hinders employees’ change-oriented organizational citizenship behavior (COCB) by increasing team chaxu climate—a phenomenon whereby team leaders maintain close connections with a minority of members and simultaneously distance themselves from the majority (Liu et al. 2009 ). This reflects the varying degrees of relationship closeness formed among team members with the controller of team resources (generally, the team leader; Liu et al. 2009 ; Shen et al. 2019 ). In Chinese enterprises, a clique culture frequently prevails, wherein leaders categorize employees into different circles—such as “inner circles” and “outer circles”—based on attitudes, relationship proximity, and capabilities (Chen and Dian 2018 ). Consequently, team chaxu climate is frequently observed within teams in Chinese enterprises. Typically, employees having a stronger—compared with those having a weaker—relationship with the resource controller receive more job-related resources (e.g., trust, support, and empowerment; Liu et al. 2009 ; Shen et al. 2019 ). According to COR theory, individuals are incentivized to conserve existing resources and acquire additional resources to prevent the risk of prospective resource loss (Hobfoll, 1989 ). We argue that narcissistic leaders exhibit behaviors deviating from their traits to access relational resources. Narcissistic leaders emphasize self-interest (Liu et al. 2017 ; Rosenthal and Pittinsky 2006 ). To conserve their resources (e.g., time and energy), they may purposefully opt to maximize their resources by forging strong ties with a small number of “trustworthy, loyal, and talented” subordinates, while maintaining a distance from the majority (i.e., maintaining resources). This differential treatment of team members by the leader increases team chaxu climate (Liu et al. 2009 ; Shen et al. 2019 ).

Furthermore, we postulate that a high level of team chaxu climate diminishes employees’ COCB. Most types of OCB do not carry the risk of offending leaders or colleagues, and hence, employees engage in these types of OCB without much consideration (Bettencourt 2004 ; Choi 2007 ). However, COCB may cause trouble for employees. Fundamentally, COCB is a proactive behavior aimed at improving organizational performance by challenging the organizational status quo, which may cause leaders to experience a sense of unhappiness and anger and deteriorate employees’ rapport with leaders (Bettencourt, 2004 ). We believe that people both inside and outside the circle are reluctant to engage in COCB because it is a high-risk behavior. In teams characterized by high levels of team chaxu climate, leaders exclusively provide key work resources to individuals within the “inner circle”—that is, the “insiders” (Liu et al. 2009 ). However, the relationship between “insiders” and “outsiders” is transient: Employees who cultivate positive relationships with leaders (for example, by affirming their views and following their instructions) may become “insiders” (Liu et al. 2009 ; Shen et al. 2019 ). Therefore, employees strive to be “insiders,” for whom, maintaining a positive relationship with the leader is a prerequisite for obtaining access to more job resources (Liu et al. 2009 ); thus, they are less likely to engage in COCB as doing so might upset the leader. On the contrary, for “outsiders,” provoking the leader might diminish their likelihood of entering the inner circle (Liu et al. 2009 ). They might refrain from COCB to obtain access to the inner circle for more resources. Therefore, we believe that “insiders” and “outsiders”—to preserve their resources and expand their access to resources—would not engage in COCB as doing so increases the risk of offending leaders.

Additionally, our hypotheses’ premise is that narcissistic leaders develop close relationships with team members only when they lack relational resources. Therefore, relational resources are key to narcissistic leaders developing close relationships with their team members. Further, related research has indicated that leaders’ attitudes toward subordinates are affected by their relationship with their supervisors as well as coworkers (Huang et al. 2020 ; Tafvelin et al. 2019 ). Unfortunately, the role of other factors (e.g., family) has rarely been considered. An individual’s behavior in the workplace is influenced by both the work environment and familial factors (Bozoğlu Batı and Armutlulu 2020 ; Staines 1980 ). Specifically, Ten Brummelhuis and Bakker ( 2012 ) proposed the W–HR model, which describes how individual resources (e.g., time, energy, and affect) link one area’s demands and resources to the other area’s outcomes. Moreover, empirical studies have indicated that individuals’ lack of relational resources in the family causes individuals to seek alternatives in the workplace (Liu et al. 2015 ; Tsang et al. 2023 ; Witt and Carlson 2006 ). Therefore, we believe that considering family factors’ impact on narcissistic leadership behavior can help obtain a more comprehensive understanding of their behavioral motivations. According to COR theory, individuals experiencing the stress of resource loss are motivated to gain resources elsewhere (Hobfoll 1989 ; Hobfoll et al. 2018 )—consistent with the W–HR perspective. Hence, we introduced family affective support as a moderating variable and posited that when narcissistic leaders cannot obtain adequate affective support at home, they become more likely to seek relational resources at work to compensate for this lack, such as by establishing fulfilling relationships with—and obtaining praise and admiration from—specific subordinates at work to alleviate the stress of resource loss at home. This behavior of narcissistic leaders precipitates team chaxu climate, which, in turn, affects employees’ COCB.

Our study makes several contributions. First, based on COR theory, we analyzed why narcissistic leaders develop deviant behaviors: Notably, narcissistic leaders develop high-quality relationships with some team members to acquire relational resources and maintain distant relationships with the majority to preserve these resources; this finding enhances our understanding of narcissistic leaders. Second, we build on COR theory to elucidate how narcissistic leadership affects employees’ COCB. Narcissistic leadership precipitates team chaxu climate owing to the discriminatory treatment of employees therein. This team chaxu climate, in turn, prevents employees from engaging in COCB, which carries a high risk of adversely impacting the leader–employee relationship. This possibly explains previous studies’ contradictory results regarding the relationship between narcissistic leadership and employees’ OCB. That is, narcissistic leadership may discourage employees from engaging in challenging and transformative OCBs. Third, we employ the W–HR perspective to introduce leaders’ family affective support as a boundary condition in our research model. We demonstrated that the family emotional support received by narcissistic leaders is critical to whether they develop a small number of cronies in the work team, thus extending the boundary conditions for narcissistic leadership behavior and empirically validating the W–HR model.

Theory and hypotheses

Narcissistic leadership and employees’ cocb.

The concept of “narcissism” originates from the ancient Greek myth that a young man named Narcissus fell in love with his reflection in the pool and finally perished because of his over self-preoccupation (Campbell et al. 2011 ). Ellis ( 1898 ) used the term “narcissism” to elucidate a pathological state of “twisted” self-affection. Subsequently, Freud ( 1939 ) proposed a distinct personality type characterized by an externally composed demeanor, assurance, and, at times, a sense of superiority. Horney ( 1939 ) expanded on this notion, suggesting that the traits exhibited by individuals with narcissistic tendencies—such as self-aggrandizement, excessively high self-regard, and the expectation of admiration from others—are rooted in qualities that they lack. Further, scholars have theorized that narcissism is a personality disorder. According to Kernberg ( 1967 ), narcissists are excessively preoccupied with the self, desperately need others’ admiration, are skilled at exploiting others, and lack empathy. By contrast, Kohut ( 1996 ) postulated that narcissism is not inherently pathological but follows a developmental trajectory. Healthy narcissism contributes to positive traits, such as humor and creativity, whereas pathological narcissism occurs when an individual cannot reconcile idealized self-beliefs with personal inadequacies, resulting in a lifelong search for validation from an idealized parental figure. Subsequent research has followed this line of reasoning. For example, Morf and Rhodewalt ( 2001b ) considered narcissism a personality trait characterized by an inflated ego, dysfunctional interpersonal relationships, and a willingness to exploit others to enhance the self. Further, Campbell et al. ( 2011 ) suggest that individuals with narcissistic traits exhibit excessive self-confidence, extraversion, high self-esteem, a strong desire for attention, and an initial charm in interpersonal interactions. However, they are resistant to criticism, possess a pronounced sense of superiority, lack empathy, are willing to exploit others, and exhibit arrogance and grandiosity (Alsawalqa 2020 ; Campbell et al. 2011 ).

Researchers investigating the relationship between narcissism and leadership behavior have found that narcissists—compared to non-narcissists—are more likely to self-promote and self-nominate (Hogan et al. 1990 ) and are more likely to be leaders in general but less likely to communicate effectively with subordinates (de Vries and Miller 1985 ; Rosenthal and Pittinsky 2006 ). de Vries and Miller ( 1985 ) highlighted narcissistic leadership’s duality, noting that some leaders evoke perceptions of strength, authority, and concern, whereas others evoke memories of intimidation, malevolence, and harm. Rosenthal and Pittinsky ( 2006 ) summarized past research pertaining to the relationship between narcissism and leadership and introduced the concept of narcissistic leadership. They held that narcissistic leaders are apathetic to others’ interests and act to suit their grandiose notions and arrogant desires. Generally, they cannot build long-term, deep relationships with others owing to their arrogance (Paulhus 1998 ; Rosenthal and Pittinsky 2006 ). They frequently disregard others’ advice, take credit for their successes, blame others for their failures (Hogan et al. 1990 ), and constantly seek validation and superiority (Morf and Rhodewalt 2001a , 2001b ; Rosenthal and Pittinsky 2006 ). However, narcissistic leaders also have a charming side as they can enhance short-term staff motivation by exuding confidence and presenting a grand vision (Ouimet 2010 ). Fatfouta ( 2019 ) summarized the advantageous and disadvantageous aspects of narcissistic leadership. On the one hand, narcissists’ positive attributes (e.g., charisma) are linked to favorable results across levels, ranging from subordinates to peers to the entire organization. On the other hand, narcissists’ negative traits (e.g., entitlement) are correlated with numerous counterproductive work behaviors, which disrupt organizational performance (Fatfouta 2019 ).

Smith et al. ( 1983 ) introduced the term “organizational citizenship behaviors.” They argue that citizenship behaviors include both altruism and generalized compliance. Altruism is a class of helping behaviors aimed directly at specific individuals, while generalized compliance refers to an objective responsibility to make the organization operate more smoothly. Notably, OCB is significant in organizations and not easily explainable by the incentives that conformity to contractual role prescriptions and high production (Bateman and Organ 1983 ; Smith et al. 1983 ). Subsequently, Organ ( 1988 ) defined OCB as voluntary individual behavior that is not immediately or expressly rewarded by the formal reward system and that contributes to the organization’s efficient functioning. Characteristic examples of organizational citizenship behaviors include demonstrating concern for the organization’s reputation and goals, offering positive and helpful feedback, and actively participating in advancing the organization (Bateman and Organ 1983 ; Organ 1988 ; Smith et al. 1983 ). Further, employees’ OCB has been receiving a great deal of attention because it can significantly benefit an organization (Bettencourt 2004 ; Mackenzie et al. 2011 ; Organ 1988 , 2018 ; Smith et al. 1983 ). Numerous previous studies on OCB have investigated affiliative behaviors, including interpersonal helping, courtesy, and compliance, which solely aim to maintain and strengthen the existing situation (Choi 2007 ). Owing to OCB research’s abundance, several behaviors aimed at changing the status quo have been classified as OCB. Subsequently, Bettencourt ( 2004 ) introduced the concept of COCB—an OCB that emphasizes challenging and transforming the existing situation. Choi ( 2007 ) elucidated this concept as the constructive effort invested by employees toward the processes and policy systems at work to optimize their performance—manifested by proposing recommendations for process improvement or implementing new working methods. Moreover, COCB has been proven to improve the organization’s efficiency and competitiveness (Mackenzie et al. 2011 ). Narcissistic leaders emphasize superiority, authority, and control (Maccoby, 2000 ); are keen to dominate others (Rosenthal and Pittinsky 2006 ); and frequently deny others’ ideas and suggestions (Hogan et al. 1990 ; Huang et al. 2020 ). This can result in employees being reluctant to propose their ideas (Liu et al. 2017 ). Additionally, narcissistic leaders frequently pursue their self-interest through manipulation and exploitation, and take credit for their subordinates’ ideas and contributions, precipitating a reduction in employees’ drive for change (Locke 2009 ) and, consequently, in subsequent OCBs (Wang et al. 2021 ). Therefore, the following hypothesis is proposed:

Hypothesis 1 : Narcissistic leadership significantly negatively impacts employees’ COCB.

Team chaxu climate’s mediating role

The concept of chaxu climate—a term originally introduced by Fei ( 1948 )—has been derived from the indigenous Chinese notion of a chaxu pattern in society. He posited that traditional Chinese society is marked by a chaxu pattern, whereby individuals are central and their interpersonal relationships radiate outward in concentric “ripple circles.” As these circles widen, interpersonal relationships’ intimacy gradually diminishes; consequently, individuals at the center engage differently with those around them (Fei 1948 ). Zheng ( 1995 ) introduced the concept of the chaxu pattern into organizational research, positing that organizational leaders classify subordinates into “insiders” and “outsiders” based on three criteria—namely, the nature of their “guanxi” (a Chinese term for personal connections or relationships), the employee’s degree of loyalty, and their competence level. Liu ( 2003 ) observed that the chaxu pattern prevalent in Chinese society may result in leaders treating employees disparately, potentially cultivating a chaxu climate within teams. Focusing on work teams, Liu et al. ( 2009 ) suggested that team-level chaxu climate is determined by the variance in close relationships between team members and team leaders, with the latter usually controlling the resources. Subordinates with closer ties to team leaders are provided more power and resources (Liu et al. 2009 ; Shen et al. 2019 ). Chinese leaders tend to segment employees into “insiders” and “outsiders,” treating them differently in terms of providing opportunities and distributing resources, thereby cultivating a prevalent chaxu climate in Chinese organizations (Peng and Zhao 2011 ; Chen and Dian 2018 ; He et al. 2022 ). These studies indicate that leaders’ differential treatment of subordinates is closely related to team chaxu climate’s emergence.

Prior research has indicated that narcissistic leaders fail to create quality relationships with subordinates (Hogan et al. 1990 ; Maccoby 2000 ; Rosenthal and Pittinsky 2006 ); however, recent research has demonstrated that narcissistic leaders may exhibit deviant behavior, such as demonstrating compassion for subordinates or involving subordinates in key decisions (Carnevale et al. 2018 ; Owens et al. 2015 ). However, they do not create solid social relationships with all employees; instead, they choose a select few to establish a high-quality relationship with and alienate the majority (Huang et al. 2020 ). This is consistent with COR theory, which holds that individuals strategically utilize their limited resources to optimize valued resources’ accumulation—notably, in forming and maintaining social relationships. Individuals are incentivized to obtain respect and affective support as important psychological resources (Hobfoll 1989 ; Hobfoll et al. 2018 ; Hobfoll and Shirom 2001 ). Narcissists rely heavily on developing psychological resources, have a strong need for self-esteem and superiority, and desire to establish a grandiose self-image (Hogan et al. 1990 ; Horney 1939 ; Kernberg 1967 ; Rosenthal and Pittinsky 2006 ). Hence, they tend to interact more frequently with those who praise and admire them than with those who do not (Brown 1997 ; Campbell et al. 2002 ; Gauglitz et al. 2023 ). Additionally, narcissistic leaders pursue superiority in a long-term, holistic manner (Morf and Rhodewalt 2001a , 2001b ) and need to alienate most of their subordinates to preserve their superiority (Bernerth 2022 ; Huang et al. 2020 ). Moreover, building relationships with others requires time, effort, and other resources (Halbesleben et al. 2014 ). Hence, being on amicable terms with all subordinates may not be worthwhile for narcissistic leaders. Therefore, narcissistic leaders cultivate subordinates who can provide them with psychological resources as “henchmen” and, concurrently, decrease engagement with subordinates who cannot provide resources to protect their limited resources. This differential treatment of subordinates by narcissistic leadership increases the team chaxu climate.

Relevant studies have indicated that when the team chaxu climate is high, the work resources available to team members are unequal, and some members—those having a desirable relationship with the leader—receive more resources. By contrast, if the team chaxu climate is low, no significant difference exists in the resources available to all members (Liu et al. 2008 ; Liu et al. 2009 ; Shen et al. 2019 ). In Chinese organizations, employees’ relationships with leaders affect the allocation of work resources (Chen and Dian, 2018 ; Liu et al. 2008 ). Leaders tend to allocate more work resources to employees with whom they have a desirable relationship (Liu et al. 2008 ; Liu et al. 2009 ). This behavior often elevates the team chaxu climate (Liu et al. 2009 ). Related research has demonstrated that employees who are disadvantaged in organizational resource allocation may be less likely to exhibit motivation for change behaviors and neglect areas of improvement at work (Abdullah and Wider 2022 ). This is consistent with COR theory’s postulation that employees only act if they obtain resources in return for their invested effort (Hobfoll 1989 ; Hobfoll et al. 2018 ; Hobfoll and Shirom 2001 ). Therefore, we believe that when team chaxu climate is high, both “insiders” and “outsiders” abandon COCB after evaluating the return on their investment of resources. Specifically, “insiders”—who have a high-quality relationship with their narcissistic leader—receive more resources than other employees do because of this relationship (Liu et al. 2008 ; Liu et al. 2009 ). Their optimal strategy involves maintaining a satisfactory relationship with their leader (Liu et al. 2009 ). However, COCB deviates from established protocols and may also be deemed unmanageable by the leader, causing the leader to lose trust in the employee and thereby deteriorating the leader–employee relationship (Bettencourt 2004 ). Moreover, the identity of the “insider” is unstable, and at any time, insiders and outsiders may interchange identities (Liu et al. 2009 ). Employees must maintain positive relationships with leaders to preserve their “insider” identity (Shen et al. 2019 ). Therefore, COCB is an unwise choice for them. “Outsiders”—who are estranged from their leaders—receive relatively few resources (especially core resources) and are at a relative disadvantage in the team, which reduces their motivation, psychological security, organizational identity, and emotional commitment (Liu et al. 2009 ; Opoku et al. 2020 ; Stinglhamber et al. 2021 ; Zhao et al. 2019 ). However, job resources, motivation, psychological safety, organizational identification, and emotional commitment are significant for employees to engage in COCB (Choi 2007 ; De Clercq 2022 ; Hu et al. 2023 ; Koopman et al. 2016 ; Wang et al. 2021 ). On the contrary, narcissistic leaders enjoy others’ praise and admiration (Morf and Rhodewalt 2001a , 2001b ; Rosenthal and Pittinsky 2006 ); for employees, obeying leaders’ instructions and agreeing with their ideas is frequently a safer “to-be-inside” technique than COCB, which carries a high risk of adversely impacting the leader–employee relationship.

In summary, we suggest that narcissistic leadership precipitates team chaxu climate owing to differentiated relational strategies for different employees, which hinders employee COCB. Accordingly, we hypothesize as follows:

Hypothesis 2 . Narcissistic leadership impacts employees’ COCB through team chaxu climate.

Family affective support’s moderating role

As postulated earlier, when narcissistic leaders lack relational resources, they develop desirable relationships with some team members. Moreover, relevant studies have confirmed that the adequacy of leaders’ relational resources affects their behavior. For example, Tafvelin et al. ( 2019 ) reported that coworker support affects leaders’ behavior at work. Huang et al. ( 2020 ) revealed that the quality of the exchange relationship between narcissistic leaders and their superiors influences their attitude toward their subordinates. This aligns with COR theory’s perspective that when individuals fail to receive the resources that they value through some social connections, they choose to seek these resources in other relationships to compensate for the risk of resource loss (Hobfoll et al. 2018 ; Wilson et al. 2010 ). These studies provide valuable insights into our understanding of narcissistic leadership behavior. However, prior research has focused solely on organizational factors and neglected the potential impact of leaders’ family-related factors. The work–family relationship model asserts that individuals’ familial and professional statuses impact each other, and they seek the experiences that they cannot obtain in one system from the other (Staines 1980 ). Particularly, Ten Brummelhuis and Bakker ( 2012 ) introduced COR theory into the work–family relationship model to construct a W–HR model to illustrate how individual resources (e.g., time, energy, and affect) connect the demands and resources of one domain to outcomes in the other domain. The W–HR model suggests that individuals’ resource adequacy status in the family domain affects their attitudes and behaviors in the work domain, and vice versa (Ten Brummelhuis and Bakker 2012 ). Moreover, subsequent empirical research has supported this idea. For example, Huffman et al.’s ( 2014 ) four-year longitudinal study revealed that employees with high—than those with low—spouse career support exhibit higher job satisfaction and lower turnover rates. Cheng et al.’s ( 2019 ) COR-theory-based study demonstrated that family stress can cause disruptive behaviors at work. Furthermore, Bozoğlu Batı and Armutlulu’s ( 2020 ) study underscored that family–work conflict affects entrepreneurs’ investment decisions.

Narcissistic leaders tend to be highly egotistical and are more sensitive to the risk of resource loss (Maccoby 2000 ). If they do not receive adequate affective support from their family, they might exhibit anxiety and depression (Bushman and Baumeister 1998 ; Miller et al. 2007 ) and become likely to seek the fulfillment of their psychological resources through other means; meanwhile, subordinates’ respect, admiration, and loyalty is an effective countermeasure against the risk of resource loss (Huang et al. 2020 ). Considering COR theory and the W–HR model, we propose that the relationship between narcissistic leadership and team chaxu climate may be influenced by family affective support.

When narcissistic leaders’ family emotional support is low, the lack of affective resources may cause them to experience resource deprivation stress (Bushman and Baumeister 1998 ; Miller et al. 2007 ); to compensate for this lack, they may try creating “cronies” in their work team (Bernerth 2022 ; Huang et al. 2020 ). Further, the risk of resource loss created by a lack of family affective support makes narcissistic leaders particularly sensitive to resource investment (Hobfoll et al. 2018 ); hence, narcissistic leaders—to maintain their inadequate resources—alienate subordinates who cannot contribute resources to them (Huang et al. 2020 ). On the contrary, when certain needs of an individual are satisfied, other needs are increasingly prioritized (Maslow, 1943 ). Thus, when narcissistic leaders receive higher family affective support, their relational resources are satisfied, and the psychological resources obtained by establishing high-quality relationships with subordinates become less effective. In this phase, their concern predominantly pertains to preserving a favorable self-image, gratifying their sense of superiority, and isolating themselves from all subordinates (Huang et al. 2020 ; Morf and Rhodewalt 2001a , 2001b ). That is, when narcissistic leaders receive high family affective support, they alienate all subordinates to maintain their sense of superiority; consequently, team chaxu climate is alleviated. Thus, we propose the following hypothesis:

Hypothesis 3 : Family affective support moderates leadership narcissism’s positive effect on the chaxu climate, with the positive effect being stronger when family affective support is low.

As discussed earlier, narcissistic leaders impact employees’ COCB via team chaxu climate, whose influence is moderated by leaders’ family affective support. Therefore, the following hypothesis is proposed:

Hypothesis 4 : Family affective support moderates the team chaxu climate’s mediating effect. The stronger the family affective support, the weaker the team chaxu climate’s mediating effect.

Accordingly, this study’s research model can be developed (Fig. 1 ).

Research model.

Sample and procedure

We administered a three-wave time-lagged questionnaire with the assistance of in-service MBA students (full-time employees pursuing weekend MBA courses) from two universities in central China. Specifically, we sent invitations to 267 MBA students with the assistance of the MBA teaching centers at both schools; the respondents were asked regarding their willingness to participate in the survey and whether their team fulfilled the criteria for participation in this study. The inclusion criteria for the respondents’ team were threefold: The respondents’ team must (1) be a formal team in the organization, (2) collaborate to complete work tasks, and (3) exhibit a need for innovation in the work tasks. Notably, 84 eligible working MBA students confirmed their consent to participate in this survey. We utilized SoJump (a professional survey agency) to administer the online survey; we entrusted the recruited students to distribute the online questionnaires to their respective work teams. Specifically, each student was requested to distribute three or more questionnaires to their respective work teams. Participation was voluntary, and respondents were assured that their responses would remain confidential and that they could withdraw at any time. At Time 1, we asked the 84 students to distribute questionnaires among their team leaders to collect data on their narcissistic leadership tendencies and level of family affective support; we received 74 valid questionnaires. At Time 2 (two weeks after Time 1), questionnaires were distributed among the 74 teams to collect data on team chaxu climate; we received 408 valid questionnaires from 68 teams. At Time 3 (two weeks after Time 2), questionnaires were distributed among the 68 teams to collect data on employees’ COCB; we received 363 valid questionnaires from 61 teams. The leaders’ sample included 43 men (70.5%)—primarily aged 26–35 ( N  = 35, 57.4%) and 36–45 ( N  = 21, 34.4%) years—and the majority had been in their positions for 6–10 years ( N  = 46, 75.2%). Of them, 60 (98.4%) held a bachelor’s degree or higher. The employees’ sample included 188 men (51.8%)—most of whom were aged 26–35 ( N  = 148, 40.8%) and 36–45 ( N  = 152, 41.9%) years; their average tenure was 3–5 years ( N  = 164, 45.2%), and 285 of them had a bachelor’s degree or higher (78.5%).

We performed independent samples t-tests for team chaxu climate as well as for the control variables. The results indicated no significant difference between respondents who answered the questionnaire only at T2 and those who did so at both T2 and T3. Team chaxu climate ( t  = −1.566, p  > 0.05), gender ( t  = −0.476, p  > 0.05), age ( t  = 0.142, p  > 0.05), educational level ( t  = −1.024, p  > 0.05), and tenure ( t  = 0.217, p  > 0.05). Additionally, the χ2 test’s results revealed no significant difference between the above two groups of respondents (gender: χ 2 [1, N  = 408] = 0.227, p  > 0.05; age: χ 2 [3, N  = 408] = 0.769, p  > 0.05; educational level: χ 2 [3, N  = 408] = 4.052, p  > 0.05; tenure: χ 2 [4, N  = 408] = 2.281, p  > 0.05).

In this study, items pertaining to narcissistic leadership and COCB were translated from English to Chinese using a translation/back translation technique; all questions were handled by one English-proficient professor and two doctoral students collaboratively and assessed on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree).

Narcissistic leadership

Jonason, Webster’s ( 2010 ) scale, which has been demonstrated to have high-quality reliability and validity in the Chinese context, was used to measure narcissistic leadership (Li and Zhang 2018 ; Zhang et al. 2017 ). This scale comprises four items. An example item is “I tend to seek prestige or status.” In this study, the Cronbach’s α for this scale was 0.866.

Team chaxu climate

Team chaxu climate was measured using Liu’s ( 2003 ) 10-item scale, which is scored by members of a team. This scale—developed in the Chinese context—is currently the most commonly utilized scale for measuring team chaxu climate (Liu et al. 2009 ; Shen et al. 2019 ). An example item is “My manager has a great deal of contact and interaction with specific subordinates on the team.” In this study, the Cronbach’s α for this scale was 0.838. We aggregate the team-level chaxu climate; the analysis results are consistent with applicable standards, whereby the ICC1 value is 0.415, surpassing the standard of 0.12. The ICC2 value is 0.808, which exceeds the standard of 0.70. The average Rwg is 0.966, exceeding the minimum threshold of 0.70 (Bliese 2000 ).

COCB was measured using Choi’s ( 2007 ) scale, which comprises four items; an example item is “I frequently come up with new ideas or work methods to perform my tasks.” Numerous related studies have demonstrated the validity and reliability of this scale, which has been widely accepted by scholars (Ha et al. 2020 ; Hu et al. 2023 ). In this study, the Cronbach’s α for this scale was 0.797.

Family affective support

Family affective support was measured using the scale edited by Li and Zhao ( 2009 ), which comprises six items; an example item is “When I am exhausted by work, my family is always encouraging.” This scale was developed based on the Chinese context and is highly compatible with Chinese customs. It has exhibited high reliability and validity in previous studies (Li and Zhao 2009 ; Shi and Wang 2016 ). In this study, the Cronbach’s α for this scale was 0.919.

Control Variables

To exclude potential factors’ influence on the outcome variables, following prior research, we used the leader’s gender, age, educational level, and organizational tenure as control variables (Huang et al. 2020 ; Zhang et al. 2022 ).

Data analysis

First, we performed Harman’s one-factor test and the Unmeasured Latent Method Construct (ULMC) to test common method biases (CMBs). Second, we incorporated variables across multiple levels. To establish discriminant validity, we conducted multilevel confirmatory factor analysis (MCFA) using Mplus 7.4. Third, we constructed a multi-level structural equation model to assess the theoretical hypotheses. Finally, we conducted a Monte Carlo simulation with 100,000 replications using R version 1.3.1 to further examine the mediation and moderated mediation effects.

Confirmatory factor analyses and common method bias test

We used Mplus7.4 to run an MCFA to detect the discriminant validity between the constructs. As Table 1 indicates, the four-factor model (χ2 = 330.015, df = 248, χ2/df = 1.331; CFI = 0.929; TLI = 0.920, RMSEA = 0.030, SRMR [within] = 0.015; SRMR [between] = 0.084) exhibits a significantly better fitting index than other alternative models, suggesting that our study’s key variables are distinguishable.

We employed two methods to test for CMB. First, the results of Harman’s one-factor test revealed that the first factor before rotation explained only 24.133% of the total variation, which did not exceed the 40% threshold. Second, the unmeasured latent method construct was used to assess the CMB. After adding the common method factor, the five-factor model’s fit (χ 2  = 299.927, df = 232, χ 2 /df = 1.293, CFI = 0.941, TLI = 0.929, RMSEA = 0.028, SRMR [within] = 0.015, SRMR [between] = 0.088) did not significantly improve, compared to the four-factor model. Collectively, these two methods indicate that the CMB in this study has been effectively controlled to a certain extent.

Descriptive statistics and correlations

Table 2 presents the correlations, means, and standard deviations.

Hypotheses testing

Figure 2 presents the results of the multilevel structural equation modeling analysis. Narcissistic leadership significantly positively impacted team chaxu climate (β = 0.317, p  < 0.001), and team chaxu climate significantly negatively impacted employees’ COCB (β = −0.328, p  < 0.001); thus, H2 is supported. The interaction term of narcissistic leadership and family affective support significantly impacted team chaxu climate (β = −0.645, p  < 0.001); thus, H3 is supported.

Path analysis results.

The interaction in Fig. 3 illustrates that when leaders’ family affective support is strong, narcissistic leadership’s impact on the team chaxu climate weakens.

Family affective support’s moderating effect on the relationship between narcissistic leadership and team chaxu climate.

Table 3 presents the results of the Monte Carlo simulation with 100,000 replications. Evidently, narcissistic leadership’s indirect effect on employees’ COCB through team chaxu climate was significant (−0.104, 95%CI [−0.153, −0.061]). Therefore, H2 is further supported. Under high family affective support (mean +1 SD), narcissistic leadership’s indirect mediating effect on employees’ COCB through team chaxu climate was not significant (0.019, 95%CI [−0.0656, 0.001]). Under low family affective support (mean −1 SD), the indirect effect was significant (−0.228, 95%CI [−0.145, −0.063]). The effect size of the difference between high and low family affective support was significant (0.247, 95%CI [0.057, 0.084]), indicating that narcissistic leadership’s indirect effect on employees’ COCB through team chaxu climate was moderated by family affective support, thus supporting H4. Narcissistic leadership’s total effect on employees’ COCB was significant (−0.306, 95%CI [−0.375, −0.239]); hence, H1 is supported.

Based on conservation of resources theory and the W–FR model, we constructed a multilevel moderated mediation model to explore how and when narcissistic leadership impacts employees’ COCB. We used team chaxu climate as a mediating variable in the relationship between narcissistic leadership and COCB to reveal the underlying mechanisms. Additionally, we explored family emotional support’s moderating role therein.

Utilizing a three-stage time-lag questionnaire, we found that narcissistic leadership negatively influences employee COCB—consistent with previous research on the relationship between narcissistic leadership and employee OCB (Ha et al. 2020 ; Li and Zhang 2018 ; Wang et al. 2021 ). On the one hand, COCB carries the risk of offending leaders (Bettencourt 2004 ; Choi 2007 ); on the other hand, narcissistic leaders may take credit for their subordinates’ contributions (Hogan et al. 1990 ). Consequently, employees are reluctant to engage in COCB. Moreover, team chaxu climate’s mediating role was supported. From a COR perspective, narcissistic leaders tend to maintain positive relationships with a select few valuable employees within their teams to gain access to relational resources, thus precipitating team chaxu climate, which, in turn, discourages team members from engaging in COCB. This explains not only why narcissistic leaders exhibit deviant behavior but also how narcissistic leadership affects employee COCB. Notably, family affective support moderates the relationship between narcissistic leadership and team chaxu climate: The stronger the family affective support received by leaders, the weaker the negative relationship between narcissistic leadership and team chaxu climate. That is, when narcissistic leaders receive sufficient affective support from their families, their need for a grandiose image outweighs their relational needs, at which point narcissistic leaders no longer need to develop relationships with a select few employees in their team to access relational resources. This corroborates the idea that a leader’s relationship with others affects their attitudes and behaviors toward subordinates (Huang et al. 2020 ; Tafvelin et al. 2019 ). Our study not only expands the boundary conditions for narcissistic leadership’s effects on employee behavior but also contributes to the W–HR model’s development.

Theoretical contributions

Our study contributes to the literature on OCB, team chaxu climate, and narcissistic leadership. First, our finding that narcissistic leaders develop relationships with their employees to acquire relational resources deepens the understanding of narcissistic leadership behavior. Earlier research argued that narcissistic leaders are selfish, arrogant, and lacking empathy, and that they fail to develop satisfactory relationships with their employees (Hogan et al. 1990 ; Maccoby 2000 ; Rosenthal and Pittinsky 2006 ). However, recent research has reported that narcissistic leaders proactively develop positive relationships with their employees and involve them in significant decisions (Carnevale et al. 2018 ; Owens et al. 2015 ). This is contrary to our previous knowledge pertaining to narcissistic leaders. However, why narcissistic leaders engage in such behavior, which deviates from their personality, has not been elucidated. Our study—based on COR theory—explains why narcissistic leaders develop relationships with their employees; specifically, it highlights that narcissistic leaders need relational resources through praise and admiration from their subordinates. This elucidates the reasons driving narcissistic leaders’ deviant behaviors (Carnevale et al. 2018 ), thus deepening our understanding of narcissistic leadership.

Second, our study revealed team chaxu climate’s mediating role in the relationship between narcissistic leadership and employees’ COCB, thereby helping us better understand the relationship between narcissistic leadership and employees’ OCB. Previous research on the relationship between narcissistic leadership and employees’ OCB has yielded inconsistent results (Carnevale et al. 2018 ; Ha et al. 2020 ; Wang 2021 ; Zhang et al. 2022 ; Zhang et al. 2017 ; Zhu et al. 2023 ), thereby underscoring the limited understanding of the association between these two constructs. To address this gap, we elucidate how narcissistic leaders impact employees’ COCB based on COR theory. Narcissistic leaders acquire and safeguard resources by favoring a select few individuals within their team to become “insiders” and alienate the majority. Such differential treatment of employees by narcissistic leaders intensifies the team chaxu climate. At this time, both the “insiders” with high-quality—and “outsiders” with low-quality—exchange relationships with leaders refrain from engaging in high-risk COCB to obtain or preserve (existing) resources. Here, we particularly emphasize the high risk associated with COCB. Unlike most milder forms of OCB, employee COCB challenges the status quo, which may be distasteful for leaders (Bettencourt 2004 ; Choi 2007 ; De Clercq 2022 ), and offending their leaders may place them under tremendous pressure of losing resources (Hobfoll et al. 2018 ; Zaccaro et al. 2001 ). Thus, both “insiders” and “outsiders” may be discouraged from engaging in such behaviors. Our study provides a possible explanation for prior research’s contradictory results on the relationship between narcissistic leadership and employees’ OCB, deepens our understanding of this relationship, and also responds to the call for further in-depth research on team chaxu climate as a local variable (Chen and Dian 2018 ).

Third, we examine family affective support’s moderating effect, in response to Huang et al.’s ( 2020 ) call to explore the boundary conditions under which narcissistic leadership contributes to mitigating narcissistic leadership’s negative effects. Previous research has found that leaders’ stock of resources significantly impacts their behavior. If leaders do not have access to relational resources with their supervisors or coworkers, they look elsewhere to supplement their relational resources (Huang et al. 2020 ; Tafvelin et al. 2019 ). Nevertheless, research discussing how narcissistic leaders’ perceived level of family support impacts their work behaviors is scant. The W–HR model explains that individuals’ need for resources at either work or at home affects their attitudes and behaviors in the other domain (Ten Brummelhuis and Bakker 2012 ). We draw on W–HR to explore how narcissistic leaders’ behavior at work changes when they do not receive sufficient emotional support at home. Reportedly, narcissistic leaders are extremely sensitive to the loss of resources (Maccoby 2000 ). When they do not receive sufficient affective support from their family, they actively seek the recognition of a select few subordinates and establish high-quality relationships with them to compensate for this lack; meanwhile, leaders who receive adequate family affective support maintain their sense of superiority in the first place and reduce their interaction with subordinates. In sum, this study deepens our understanding of narcissistic leadership behavior’s boundary conditions and empirically validates the W–HR model.

Practical implications

This study’s findings have the following implications for organizational practice: First, companies must recognize that narcissistic leadership negatively impacts employees’ COCB. Narcissistic leaders habitually reject others’ opinions to maintain a sense of superiority (Hogan et al. 1990 ) and may also take credit for their subordinates’ innovations (Hogan et al. 1990 ; Rosenthal and Pittinsky 2006 ), precipitating employees’ reluctance to engage in COCB. This indicates that narcissists are not suited for leadership positions. Consequently, to avoid narcissistic leadership’s negative effects, organizations should screen for narcissistic personality traits when considering individuals for leadership positions and avoid promoting excessively narcissistic individuals to such positions. Moreover, the leader candidate’s peers or subordinates should be asked to assess their narcissism level, as narcissists tend not to exhibit their excessive narcissistic tendencies in front of their superiors but might present their true selves in front of their peers or subordinates (Campbell et al. 2011 ).

Second, organizations should adopt measures to reduce team chaxu climate. Per previous research, team chaxu climate forms an evident “circle phenomenon” within the team, thus decreasing employees’ performance and OCB (Shen et al. 2019 ). Furthermore, we found that neither “insiders” nor “outsiders” engage in COCB if the team chaxu climate is high. Therefore, the organization’s top managers should adopt measures to prevent the development of team chaxu climate. For example, the implementation of a teamwork resource-sharing model and a combination of team and individual performance appraisals can help avoid narcissistic leadership’s negative effects as well as provide psychological and work resource support for employees’ COCB.

Third, organizations must focus on their team leaders’ relational resource status. Previous research has demonstrated that among narcissistic leaders, the experience of relational resource stress intensifies their personality’s negative aspects (Huang et al. 2020 ). Moreover, we found that when narcissistic leaders do not receive sufficient emotional support in their families, they treat subordinates within their team differently, thus developing team chaxu climate. This, in turn, reduces the likelihood of employees’ COCB. However, when narcissistic leaders are provided with sufficient relational resources in the family (family emotional support), they do not treat team employees differently and the negative effects disappear. This indicates that senior managers should focus more on—and provide greater support to—team leaders. For example, communicating more frequently with team leaders and extending goodwill and support can effectively mitigate their psychological pressure (Li et al. 2023 ).

Conclusion, limitations, and future research

This study has some limitations. First, although we collected data utilizing a multi-source and multi-wave approach, this study does not employ a rigorous longitudinal study design; hence, it cannot definitively determine the causal relationship between narcissistic leadership and employees’ COCB. Arguably, employees’ COCB may cause leaders to reflect on their narcissistic leadership behaviors, thus reducing such behaviors. Our research model is consistent with the theoretical ordering of variables in the input–process–output (I–P–O) framework (Mathieu and Taylor 2006 ): Team inputs (narcissistic leadership) impact team processes (team chaxu climate), which, in turn, impact output (COCB). Nevertheless, we encourage future scholars to conduct rigorous longitudinal studies or field trials to assess the causal relationship between narcissistic leadership and employees’ COCB.

Second, our study focused specifically on the relationship between narcissistic leadership and COCB—a risky behavior; however, most other OCBs are less risky (Bettencourt 2004 ). Future research must examine the relationship between narcissistic leadership and other types of OCBs. For example, how narcissistic leadership affects service-oriented OCBs. Understanding the relationship between narcissistic leadership and different types of OCBs can help us better explain prior studies’ inconsistent results regarding the relationship between narcissistic leadership and employees’ OCB.

Third, although our study revealed the moderating role of leaders’ family affective support, most current research focuses on intra-organizational factors’ impact on narcissistic leadership behaviors (Huang et al. 2020 ; Tafvelin et al. 2019 ). Research on extra-organizational factors’ impact on narcissistic leaders’ behavior in the workplace is scant. We encourage future research to examine extra-organizational situational factors that can impact narcissistic leadership behavior. For example, future research can examine whether narcissistic leaders—in high-uncertainty environments—develop positive relationships with all team members to maintain their status and ensure team performance. This can be useful in furthering the current understanding of narcissistic leaders.

Fourth, we focused solely on a singular category of employee contributions in relation to leadership behavior—namely, employees’ COCB. Other employee contributions may also be affected by narcissistic leadership and team chaxu climate. For example, team chaxu climate attributable to narcissistic leadership can cause members to distrust each other, thus decreasing team performance. We suggest that future research should examine these other outcomes of leader narcissism and the resultant team chaxu climate.

Finally, most sample data in this study originate from organizations in China; hence, regional culture may have influenced the findings. Specifically, the mean for narcissistic leaders in our sample was 2.77 (5-point scale)—somewhat different from sample means in other national studies. For example, the narcissistic leadership mean in Aboramadan et al.’s ( 2020 ) study was 3.57 (5-point scale) and that in Ghislieri et al.’s ( 2019 ) study was 2.31 (5-point scale), suggesting that leaders from different cultures exhibit different narcissism levels. Therefore, future studies should employ samples from different cultures to cross-validate this study’s findings.

Data availability

The datasets generated during the current study are available in the Harvard Dataverse repository ( https://doi.org/10.7910/DVN/MUZS1X ).

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Fang, Y., Liu, Y., Yu, P. et al. How does narcissistic leadership influence change-oriented organizational citizenship behavior? Empirical evidence from China. Humanit Soc Sci Commun 11 , 667 (2024). https://doi.org/10.1057/s41599-024-03159-2

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Narcissistic Personality Disorder in Clinical Health Psychology Practice: Case Studies of Comorbid Psychological Distress and Life-Limiting Illness

Narcissistic Personality Disorder (NPD) is characterized by a persistent pattern of grandiosity, fantasies of unlimited power or importance, and the need for admiration or special treatment. Individuals with NPD may experience significant psychological distress related to interpersonal conflict and functional impairment. Research suggests core features of the disorder are associated with poor prognosis in therapy, including slow progress to behavioral change, premature patient-initiated termination, and negative therapeutic alliance. The current manuscript will explore challenges of working with NPD within the context of life-limiting illness for two psychotherapy patients seen in a behavioral health clinic at a large academic health science center. The ways in which their personality disorder affected their illness-experience shared significant overlap characterized by resistance to psychotherapeutic change, inconsistent adherence to medical recommendations, and volatile relationships with providers. In this manuscript we will (1) explore the ways in which aspects of narcissistic personality disorder impacted the patients’ physical health, emotional well-being, and healthcare utilization; (2) describe psychotherapeutic methods that may be useful for optimizing psychosocial, behavioral, and physical well-being in individuals with comorbid NPD and life-limiting disease; and (3) review conceptualizations of NPD from the DSM-5 alternative model for assessing personality function via trait domains.

Introduction

Narcissistic Personality Disorder (NPD) is a psychological disorder characterized by a persistent pattern of grandiosity, fantasies of unlimited power or importance, and the need for admiration or special treatment. Core cognitive, affective, interpersonal, and behavioral features include impulsivity, volatility, attention-seeking, low self-esteem, and unstable interpersonal relationships 1 that result in a pervasive pattern of interpersonal difficulties, occupational problems, and significant psychosocial distress. Prevalence estimates of NPD range from 0 to 6.2% in community samples. 1 , 2 Of those individuals diagnosed with NPD, 50%–75% are male. 1 The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) 1 classifies NPD as a Cluster B (“dramatic, emotional, and erratic”) personality disorder, a category that also includes Antisocial, Borderline, and Histrionic Personality Disorders.

Individuals with NPD experience significant physical and mental health comorbidities and social problems. Stinson and colleagues 2 found high 12-month prevalence rates of substance abuse (40.6%), mood (28.6%), and anxiety (40%) disorders among participants with a diagnosis of NPD. Core features of NPD that contribute to these mental health comorbidities include a higher frequency of experiencing shame, helplessness, self-directed anger, higher admiration of self, 3 and impulsivity. 4 NPD is a significant predictor of (a) making multiple suicide attempts, 5 (b) using lethal means to attempt suicide, 6 and (c) making suicide attempts in proximal relationship to being fired or experiencing domestic, financial, or health-related problems. 7 Regarding physical health outcomes, individuals with Cluster B personality disorders, including NPD, have demonstrated significantly higher mortality rates due to cardiovascular disease than those without personality disorders, even after controlling for relevant medical comorbidities. 8 , 9 NPD specifically is also associated with gastrointestinal conditions. 9 Not unexpectedly, NPD is strongly associated with high health care utilization across a variety of services. 8 , 10 Additionally, provider-patient relationships among individuals with NPD can be challenging due to interpersonal dysfunction marked by dramatic, emotional, and erratic thinking and/or behavior. From a behavioral standpoint, individuals with a Cluster B diagnosis are more likely to have (a) a criminal conviction (b) spent time in prison, (c) a history of interpersonal violence, 8 (d) caused pain or suffering to others, 8 and (e) evidenced overall impairment in social role functioning. 8

In terms of treatment, a limited body of research has investigated interventions for NPD using randomized controlled trials or other methodologically rigorous approaches. One systematic review published by Town and colleagues 11 found eight studies of “moderate” scientific rigor that demonstrated the positive effect of short-term psychodynamic psychotherapy (STPP). Several researchers have examined the impact of NPD on the psychotherapeutic relationship. 12 – 14 Tanzilli and colleagues 14 found that individuals treating patients with NPD were more likely to experience negative counter-transference feelings of disengagement as well as feeling criticized or mistreated. These authors highlight the core feature of narcissism—struggle to form intimate relationships—as a significant barrier to positive treatment outcome, due to the patient’s potential inability to form a safe and trusting relationship with the therapist. Other researchers have found that individuals with NPD have higher rates of self-terminating treatment. 15

One proposed treatment method for personality disorders was originally developed with the goal of providing brief psychological services to individuals with substance use disorders or medical nonadherence concerns. This approach revolves around the six-component “FRAMES” technique developed by Miller and Sanchez. 16 This method emphasizes the role of Feedback, Responsibility, Advice, Menu of Strategies, Empathy, and Self-Efficacy. This approach highlights guidelines for the patient and therapist in order to maximize the likelihood of behavioral change and therapeutic progress. 16 , 17 This strategy creates a structure in which the provider can limit the impact of transference and countertransference on the therapeutic process and focus on creating a team-oriented dynamic that is supported by limit-setting, strong boundaries, and minimization of “splitting” with other providers.

The following case studies describe the particular challenges of working with two adult patients with NPD in a clinical health psychology practice within a large academic health center in the Southeast United States.

Reasons for referral and presenting problems

Mr. X is a middle-aged, Caucasian male who was referred to the Psychology Clinic for assessment and treatment of depression. Medical record review revealed a complex medical and psychiatric history including several acute illnesses, multiple psychological conditions, a history of suicidality and involuntary psychiatric admission, as well as lack of adherence to behavioral recommendations regarding diet, exercise, and medication compliance. Approximately one year prior to his intake at our clinic, Mr. X experienced a life-threatening medical crisis. He noted that he hoped psychotherapy would support him in the goal of finding new meaning in his life.

At the time of his initial intake, Mr. X presented to the Psychology Clinic with an unusually long list of medical and mental health diagnoses. His primary concern during the initial phase of his treatment was depression. Although Mr. X’s unique personality was appreciated immediately, it was not until many months into treatment when behavioral patterns suggestive of a personality disorder emerged. After recognizing Mr. X’s pattern of volatile interpersonal encounters that was suggestive of either Borderline Personality Disorder or Narcissistic Personality Disorder (according to the guidelines explicated in the DSM-5), other symptoms indicative of NPD began emerging, particularly when standard treatment approaches were met with resistance and individual appointments often turned into crisis management sessions. The most salient features of NPD that interfered with Mr. X’s treatment progress were thoughts of grandiosity, need for admiration or special treatment, and fantasies of unlimited power or importance. For example, Mr. X regularly cancelled therapy sessions the same day of his appointment due to vague complaints; when he returned to session, he elaborated on these concerns with excessive detail in an attention-seeking manner. Similarly, his referral physician reported feeling compelled by Mr. X to treat him for unsubstantiated medical complaints.

Mr. X initiated his first session by describing the many “illustrious” mental health providers from whom he had received treatment. He described his goals for psychotherapy, which included growing his religious faith and practice, exploring lifelong questions regarding intimacy, and increasing the size of his social network. Mr. X engaged in two years of individual cognitive-behavioral therapy marked by numerous distractions that impaired his ability to focus on broader values-based treatment goals. Although efforts were made to assist him in gaining insight into the way in which personality factors influenced behavioral patterns and interpersonal difficulties, Mr. X benefitted primarily from concrete treatment approaches designed to address specific behavioral problems (i.e., poor adherence to medical recommendations).

Ms. Y is a middle-aged, Caucasian female who was referred by her oncologist for evaluation and management of distress in the context of diagnosis and treatment of cancer. Ms. Y presented for cancer treatment from out-of-state after seeking treatment recommendations from multiple well-known cancer centers throughout the United States. She was reportedly counseled by each facility that seeking multiple opinions would delay treatment and result in disease advancement and shortened survival. One center declined to treat her, as they believed that she did not seem able to engage in a collaborative relationship with medical team members. Once Ms. Y began treatment at our facility, she sought medical care for vague or minor symptoms from almost every department in our medical center. While her cancer diagnosis and potential side effects of treatment were well-documented, Ms. Y demonstrated a pattern of attention-seeking behavior, similar to that displayed by Mr. X, in which hypervigilance about minute changes in physical sensation or function were treated like emergencies that required urgent care. Ms. Y’s social history was remarkable for having a young child of whom she lost custody, multiple ex-boyfriends with whom she had tumultuous relationships, a current boyfriend, and a very supportive mother. Ms. Y reported receiving but not completing graduate medical training. Medical record review revealed the additional history that she was dismissed from graduate training and barred from seeking a health care practitioner license in several states due to academic and professional behavior issues.

Features of a personality disorder emerged within minutes of beginning Ms. Y’s intake in our training Clinic. Once settled in the interview room, Ms. Y called the trainees “incompetent,” and insisted that she would only see “the Attending.” Once the Attending Psychologist entered the room, she cried out loudly that she felt as if she had been sexually victimized. Upon clarification, she explained that this was in reference to being asked by a male health care provider to disrobe and change into a medical gown for a CT scan several months ago. This highly atypical and dramatic presentation, in conjunction with her reported history of exceptionally volatile interpersonal relationships, immediately alerted our team to the high likelihood of the presence of a severe personality disorder. Our medical record review and diagnostic interview yielded concrete evidence in support of a personality disorder diagnosis with prominent NPD features. Ms. Y provided a plethora of personal anecdotes, which further supported this diagnosis. Conceptualizing her case from within an NPD framework brought awareness and appreciation of the unique challenges of working with individuals with this disorder. This was a crucial initial step toward assisting Ms. Y with her primary goal of achieving and maintaining the interpersonal stability necessary to complete cancer treatment. Her self-reported history and behavior in the Clinic were consistent with key features of NPD, including relational volatility, excessive demands for special treatment, disdain for others’ emotional experiences, and lack of empathy. Moreover, her tendency toward hypersensitivity and negative automatic thought patterns regarding perceived insults from most individuals with whom she came into contact, including medical providers with whom she needed to collaborate in order to obtain life-preserving cancer treatment, resulted in persistently paranoid ideation. These symptoms of NPD caused her distress and served as barriers to obtaining successful medical and psychological treatment. As an aside, Mr. X demonstrated similar tendencies toward paranoia in terms of presuming that even subtle changes within the dynamics of existing interpersonal relationships were indicative of negative underlying motivations on the part of others. For both patients, this resulted in volatile relationships in personal and medical contexts.

Interestingly, Ms. Y herself confirmed a prior personality disorder diagnosis—which she referred to as “mixed personality disorder” with narcissistic features—within the context of discussing her history of difficult relationships with medical providers. However, Ms. Y did not provide specific information as to when, by whom, or under what criteria she had received this diagnosis. Ms. Y also disclosed anxiety about maintaining collaborative relationships with her treatment team. She expressed uncertainty about her ability to manage her distress related to her diagnosis, grief over interpersonal losses, and worry about the effects of cancer and treatment on her self-esteem, body image, and sexual functioning. Given that Ms. Y intended to move back to her residence in another state upon completion of her cancer treatment, brief therapy was indicated. The main goal of treatment was to increase Ms. Y’s capacity for distress tolerance so that she would be able to complete intensive cancer treatment. A secondary goal was to provide her with a positive psychotherapy experience in order to assist her with transitioning to longer-term psychological treatment upon her return home. She attended four, 50-minute, cognitive-behavioral therapy sessions. She achieved her goal of managing her distress in a manner that allowed her to complete her cancer treatment successfully. Given the brevity of the treatment that she received, we were unable to target major mood disturbance or core personality features. Thus, depression was not significantly reduced. However, she experienced a reduction in hopelessness and a remission in suicidal ideation during the course of her treatment. She also expressed that she had an overall positive experience in therapy and noted that she wished to pursue additional sessions upon return for routine follow-up care.

The following discussion highlights two crucial aspects of understanding NPD within Clinical Health Psychology practice: (1) how NPD manifests within psychotherapy in health care settings, and (2) specific ways in which these cognitive-behavioral patterns interfere with both medical and psychological treatment progress among individuals with NPD. Key ways in which NPD manifests in psychotherapy from a cognitive behavioral standpoint include: superlative self-talk and self-aggrandizement, expectations of special treatment, poor behavioral health adherence and difficult relationships with providers, and low distress tolerance. These aspects of the patients’ interpersonal style negatively affected treatment due to: poor boundaries with the therapist, ambivalence about change associated with fragile self-esteem, cognitive distortions (i.e., black-and-white thinking), and help-rejecting behaviors. An additional barrier to treatment progress underlying each of the above issues resulted from both patients’ tendency toward hypersensitivity and paranoia in therapy and in their everyday lives; both patients experienced interpersonal instability due to perceived insults and injuries of varying seriousness, which emphasized content that is clearly tied to core beliefs associated with narcissistic pathology.

Manifestations of NPD in brief and long-term psychological treatment

Superlative self-talk and self-aggrandizement.

Mr. X revealed a persistent pattern of self-glorification and a need to highlight his exceptional uniqueness in therapy. Over the course of his treatment, he repeatedly mentioned his “genius IQ,” his prodigious talents, and his exceptional ability to help others in need. Early in treatment he expressed concern regarding whether his therapist would be able to handle the complexities of his life story. He displayed a sense of self-satisfaction while relaying shocking, fantastical, or dramatic anecdotes from his life in which he often was the victim of disappointing circumstances or betrayal. He returned often to the idea that he was destined for some great purpose.

Ms. Y evidenced similar self-aggrandizement, including making frequent statements such as “I know I’m brilliant” and “I know more than [my medical providers] about my cancer treatment.” Her exaggerated self-worth was evident also in her perception of herself as highly sexually desirable to both men and women, especially those who are of high-status. Consistent with this, she reported a history of engaging in sexualized discourse and sexual relationships with health care providers and other professionals with whom she was under contract as well as a history of being sexually victimized/harassed by such individuals with pending litigation.

Expectation of special treatment

Mr. X repeatedly arrived 20 minutes early to his psychotherapy sessions seeking extra attention and lingering after his check-in to chat with Clinic staff. He frequently requested that the therapist extend his sessions, schedule additional sessions per week, and/or return multiple calls outside of session per week. Throughout treatment, Mr. X reminded the therapist about the celebrated health care providers with whom he had worked. He repeatedly compared his care to the services he received for many years at a prestigious medical school. He also noted even the slightest inconveniences he encountered at the Clinic, such as difficulty finding parking or not having a call returned quickly enough.

During treatment, Ms. Y would call at her appointment time to indicate that she would be 30 minutes late. However, when her appointment was rescheduled for that time, she would then arrive 30 minutes late to that appointment. As noted previously, she declined to receive services from pre-doctoral trainees due to their “incompetence” and expected that she would receive services solely from the Attending Psychologist, whose credentials she closely queried. Although she agreed to be treated by a postdoctoral trainee for therapy, she repeatedly advised the therapist that she found her care in the clinic unsatisfactory due to our department being “weak.” Expectations for special treatment extended to her cancer treatment team. Ms. Y demanded to receive cancer treatment on a federal holiday when the cancer center was closed. In addition, she used the oncology on-call service to obtain after-hours consultation about minor, nonurgent concerns, such as losing several tenths of a pound of weight.

Poor behavioral health adherence and difficult relationships with health care providers

Mr. X frequently failed to engage in self-care behaviors that were crucial to maintaining his health, such as dietary restrictions, CPAP usage, fluid intake management, consistent medication usage, and the wearing of compression socks. Additionally, Mr. X frequently alternated between idealizing and devaluating his physicians and their teams such that they were either at the top of their fields or completely inept. Mr. X often, to his own detriment, disagreed with his providers’ treatment plans and/or the manner in which they delivered care. For example, his cardiologist recommended that he discontinue use of a particular medication prior to completing a cardiac stress test. However, Mr. X decided that it would not be safe to stop using this medication. He also refused to complete the stress test due to concern that he would have a heart attack. Although Mr. X’s anxiety about the risks associated with this procedure was abundantly clear, he attributed his actions to superior knowledge of his body as compared to his medical providers.

Ms. Y sought multiple consultations regarding the management of her cancer, both prior to and during her treatment at our facility. She reported that several previous medical providers had discharged her from care due to her inappropriate behavior and an inability to form collaborative working relationships. She reported feeling abandoned by these providers, who she described as incompetent. She also noted that she filed complaints against them with state medical boards. At our facility, she was insistent upon receiving a new, highly specialized, and difficult-to-access cancer treatment. However, the oncology team at our facility did not recommend this treatment for her, which she repeatedly questioned and viewed as incompetence. This pattern of idealization and devaluation was also evident in therapy. When the therapist responded to Ms. Y’s suicidal ideation by conducting a risk assessment, Ms. Y stated that this was a waste of time and an indicator that the therapist was incompetent. Although the therapist was able to navigate these conflicts in a way that maintained the therapeutic relationship, Ms. Y continued to criticize the therapist and emphasize her dissatisfaction with her care.

In contrast to Mr. X, who struggled with adherence, Ms. Y was remarkably adherent to her cancer treatment and providers’ recommendations. This may have been at least partly due to the fact that her providers engaged her fully in her treatment planning and acknowledged and honored her objectively high level of knowledge about her cancer and its treatment.

Low distress tolerance

Mr. X demonstrated significant difficulty with tolerating ambiguous emotional experiences in which his self-worth was challenged. He frequently referred to difficult emotional experiences as “crises” and appeared to rely on the therapist rather than develop his own internal stress management skillset. Throughout treatment, Mr. X relayed multiple scenarios in which the experience of vulnerability in interpersonal relationships led to a pattern of emotionally charged, rapidly escalating encounters that almost always led to the demise of the relationship in question. Mr. X attempted to replicate this pattern several times with the therapist when he felt threatened by therapeutic challenges and/or boundary setting.

Similarly, Ms. Y was observed to experience difficulties with emotion regulation and distress tolerance. She described the possibility of not receiving the specialized cancer treatment that she was seeking as “the biggest regret of my life.” She indicated that routine clinical situations, such as being asked to disrobe and wear a hospital gown, were traumatic and sexually violating. Her affect was intense, dramatic in presentation, and out of proportion to events experienced. Her high level of distress prompted her to engage in excessive health care utilization and to expect that her concerns would be addressed immediately and fully. While undergoing medical treatment, she was experienced by clinical support staff on one occasion as aggressive and threatening. Outside of relationships with medical providers, Ms. Y endorsed a long history of volatile relationships with romantic partners, employers, and attorneys.

Challenges associated with NPD in psychological treatment

Poor boundaries.

Mr. X frequently challenged normative therapist-patient boundaries. He called the therapist excessively between sessions, requested extra time during his sessions, and insisted on giving the therapist a holiday gift. When presenting the therapist with a box of chocolates, Mr. X stated, “I know you are not supposed to accept presents, but you have no choice and will be taking that home with you.” He frequently made comments to the therapist in which he acknowledged a rule or boundary and then appeared to take pleasure in crossing these lines. Mr. X consistently treated the therapist overly informally, often complimenting her clothing, asking an increasing number of personal questions, or cursing during session.

Ms. Y also experienced difficulties with establishing and maintaining appropriate interpersonal boundaries in professional relationships. In particular, her rigidly held beliefs regarding the inferiority of a wide variety of groups of individuals threatened her ability to form respectful and effective relationships with diverse employers and health care providers. During her second therapy session, Ms. Y openly stated that the therapist’s country of origin and accent were problematic for her, noting that she had previously received substandard health care from individuals born outside the United States. The therapist used this opportunity to explore with Ms. Y how observing firm, prescribed boundaries with her health care providers could enhance her health care outcomes.

Ambivalence about change

Another prominent theme in Mr. X’s treatment revolved around his ambivalence regarding therapeutic change. Mr. X frequently asked the therapist to challenge him in certain ways and then responded negatively upon being challenged. When given therapy homework assignments, Mr. X frequently did not complete them; instead, he insisted on editing published worksheets, and/or amending the guidelines for prescribed exercises. He often identified therapeutic goals but strayed from them when discussions touched on painful subjects. Notably, Mr. X demonstrated particular difficulties with being interrupted. During some sessions, he lightheartedly noted that he was aware of his tendency to be verbose and gave the therapist “permission” to cut him off if he was being overly tangential. However, other times he became defensive and angry when the therapist attempted to redirect him without his permission. Mr. X’s inconsistent response to interruptions revealed a sense of ambivalence regarding his participation in the therapeutic process.

In contrast to Mr. X, Ms. Y expressed awareness of her personality structure and articulated strong motivation to mitigate her distress, complete her cancer treatment, and achieve future goals, such as seeing her child graduate from college. The value she placed on the role of motherhood, coupled with the life threat of a cancer diagnosis, appeared to be primary motivators for change.

Cognitive distortions

Consistent with firmly held beliefs about his specialness, Mr. X revealed a pattern of negative, all-or-nothing thought processes. He frequently struggled to see multiple perspectives on an issue and devalued others who were not able to see his perspective. This tendency resulted in a vicious cycle of unrealistic goal-setting, feelings of failure, and low mood which often impaired his ability to make progress in treatment.

Ms. Y also expressed a number of distorted beliefs about herself, her world, and her future. Her inflated self-concept did not appear to be grounded within objective academic, employment, or interpersonal histories. Additionally, she held many negative expectations of others based on distorted beliefs about how individuals from various socioeconomic, educational, and demographic backgrounds think, feel, and behave. These beliefs led to significant emotional dysregulation, poor distress tolerance, and interpersonal chaos with her medical providers and others in her life.

Help-rejecting behaviors

Mr. X frequently engaged in self-sabotaging behavior related to treatment goals. He cancelled almost the same number of scheduled sessions that he had completed over a two year period. He often maintained that the cancellations were due to medical exacerbations but later revealed that he was experiencing some sort of psychosocial distress. Mr. X also became angry with his medical providers due to his preoccupation with minor details regarding the speed and efficiency with which they served him. After a particularly emotional session during which the therapist encouraged Mr. X to explore his feelings surrounding one of his greatest life regrets, Mr. X called the Clinic and reported that he needed to speak to his therapist’s supervisor and to be assigned a new therapist. Mr. X lashed out at the therapist via her supervisor by questioning her competency. However, after several delicate discussions, Mr. X resumed work with the therapist. He spent months dramatically alluding to difficulties in trusting the therapist and the burden of rebuilding the therapeutic relationship.

Ms. Y’s pursuit and then rejection of cancer treatment recommendations from numerous cancer centers across the United States is consistent with help-rejecting behavior that occurs in NPD. However, once she decided to receive care at our facility, she was observed to be adherent to her treatment recommendations and actively engaged in her own care.

Summary of results

These cases demonstrate the complex relationship between manifestations of NPD and challenges to psychotherapeutic progress in a hospital-based clinical and health psychology practice. Mr. X and Ms. Y both demonstrated features of NPD during the course of their treatment. Mr. X indicated during his first session that he sought long-term psychotherapy in response to recovering from a medical crisis and re-evaluating his goals moving forward. Although he experienced many personality-based barriers to progress in psychotherapy, he was able to work through multiple therapeutic ruptures and maintain a strong relationship with the student therapist that was grounded in humor, authenticity, and direct communication. He also demonstrated some growth in personal insight regarding the ways in which his tendency toward black-and-white thinking affects his mood and daily function, particularly in terms of his relationships. However, in many ways, his dramatic and avoidant tendencies precluded his ability to make prominent changes in worldview or interpersonal style.

Ms. Y, on the other hand, entered treatment when in the throes of a perceived medical crisis due to distress associated with her cancer diagnosis and a lack of confidence in her ability to manage the complex emotions associated with a potentially life-threatening illness. At the time of her referral, her medical team’s primary goal was to reduce her stress and improve her emotion regulation enough that she would be able to engage in an appropriate manner with her medical team in order to successfully complete her cancer treatment. Unlike Mr. X, it did not appear as if Ms. Y sought long-term, deep, existential therapy that would allow her to explore her complex history or goals for the future. Therefore her treatment was more problem-focused in order to reduce barriers to successful cancer treatment.

As previously reflected, treatment challenges for patients with NPD in clinical health psychology include: (1) poor boundaries, (2) ambivalence about change, (3) cognitive distortions, (4) idealizing and devaluing providers, (5) poor behavioral health adherence, and (6) help-rejecting behaviors. Table 1 summarizes psychotherapy treatment challenges related to key features of NPD and identifies how these behaviors were demonstrated by each patient.

Behavioral examples of treatment challenges in clinical health psychology practice.

The cases discussed above highlight many prominent features of NPD as displayed by two patients receiving psychotherapy in a clinical health psychology practice within an academic teaching hospital. These patients shared a lifelong history of distress associated with unmet expectations, unrealized goals, and unfulfilling relationships. Both patients had sought psychotherapy and pharmacologic treatment throughout their lives and both presented to our clinic seeking support while dealing with chronic and potentially life-limiting illnesses. While there were many shared experiences between these two patients, there were some crucial differences. Mr. X explicitly sought long-term supportive therapy, while Ms. Y engaged in brief, problem-focused treatment. Mr. X was socially isolated and estranged from all living family members, while Ms. Y maintained a close, emotionally supportive relationship with her mother. Additionally, Mr. X demonstrated significant resistance to behavior change as manifested by inconsistent attendance, poor homework completion, avoidance of emotionally difficult topics, and lashing out at the therapist when he felt she had offended him. However, Ms. Y was motivated and receptive to treatment. Although her depressive symptoms did not resolve over the course of her brief treatment, her sense of hopelessness and suicidal ideation both decreased.

These cases highlight the complex experiences of individuals with NPD and those who work with them in clinical settings. The similarities in these cases offer support for core features of NPD as a unique condition, while the differences in their life experiences is suggestive of the variability that may affect psychological treatment course and outcomes. Mr. X made some progress on therapeutic goals but continued to be limited in his ability to engage on a deeper level due to ongoing medical management issues and psychological avoidance. Ms. Y terminated treatment after four sessions. However, psychological treatment may have played a crucial role in her ability to manage distress while enduring the challenges of cancer treatment.

A prominent challenge in the conceptualization of NPD cases revolves around the heterogeneity in presentation of the disorder and significant symtomatologic overlap with other Cluster B personality disorders. In particular, the DSM-5 Cluster B disorders share significant symtomologic overlap in terms of excessive attention-seeking, emotion dysregulation (i.e., impulsive rage), inappropriate sexual behavior, and unstable views of others (i.e., fluctuating between idealizing and devaluing). 1 Consistent with this, although NPD diagnoses were favored for Mr. X and Ms. Y, both demonstrated features of Histrionic Personality Disorder, Borderline Personality Disorder, and Antisocial Personality Disorder. However, both patients’ most prominent, distressing, and impairing symptoms and behaviors were those that are unique to the DSM-5 diagnostic criteria for NPD (i.e., arrogance, grandiosity, and need for admiring attention). Further, both patients demonstrated a relative stability of self-image, a relative absence of deceit, and a relative lack of conduct disorder/criminal history, 1 suggesting an absence of several defining features of Borderline Personality Disorder and Antisocial Personality Disorder. As such, NPD diagnoses appeared to best account for these patients’ distress and impairment at the time of presentation for treatment. However, it is possible that other Cluster B disorders may be more prominent for these patients in different circumstances (i.e., health vs. family stressors).

Conclusions

The diagnostic framework used to explore pathological narcissism in the above cases was organized according to the DSM-5 criteria. 1 These criteria were developed with an underlying assumption that personality disorders can be characterized into independent clusters and independent clinical syndromes. Recent consideration has been given to an alternative model. Working under the assumption that personality disorders have significant clinical overlap, the dimensional approach argues that pathological personality features may represent a wide range of fluid presentations that begin with normal personality function. This alternative model is explicated in an appendix to the DSM-5 and describes the ways in which personality function may vary between individuals on four dimensions: Identity, Self-Direction, Empathy, and Intimacy. Additionally, further consideration is made regarding personality function on five dimensional scales: negative affectivity, detachment, antagonism, dis-inhibition, and psychoticism. 1 The exploration of these dimensional scales may allow clinicians to conceptualize patients in a way that they are able to work around limitations in categorical diagnostic criteria in order to improve the likelihood of symptom reduction and improved quality of life.

A brief reconceptualization of Mr. X and Ms. Y’s histories from within the new model of personality disorders allows us to examine their personalities within the domains described and to rate their level of dysfunction from 0 (Little or no impairment) to 4 (Extreme Impairment). This system allows clinicians to assess symptoms at multiple levels of emotional function rather than being forced to identify a single disorder that captures the entirety of the patient’s history and present difficulties. This system is also useful in addressing the problem of overlap among within-cluster disorders.

Overall these case studies and the literature reviewed highlight: (1) the importance of provider familiarity with personality disorder symptom profiles and evaluation, (2) the significance of personality disorders in affecting medical and psychological treatment course and outcomes, (3) the potential impact of treating personality disorders on provider function and well-being, and (4) potential future directions for research on how to improve treatment outcomes for individuals with personality disorders, and NPD specifically, where obstacles to forming the crucial therapeutic alliance may have a critical impact on patient prognosis.

How Does Narcissistic Abuse Affect Future Relationships?

Anna Drescher

Mental Health Writer

BSc (Hons), Psychology, Goldsmiths University, MSc in Psychotherapy, University of Queensland

Anna Drescher is a freelance writer and solution-focused hypnotherapist, specializing in CBT and meditation. Using insights from her experience working as an NHS Assistant Clinical Psychologist and Recovery Officer, along with her Master's degree in Psychotherapy, she lends deep empathy and profound understanding to her mental health and relationships writing.

Learn about our Editorial Process

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Julia Simkus

Editor at Simply Psychology

BA (Hons) Psychology, Princeton University

Julia Simkus is a graduate of Princeton University with a Bachelor of Arts in Psychology. She is currently studying for a Master's Degree in Counseling for Mental Health and Wellness in September 2023. Julia's research has been published in peer reviewed journals.

On This Page:

Narcissistic abuse is a form of emotional and psychological abuse where a person manipulates, exploits, and demeans their partner to maintain control and power over them. It often involves behaviors such as gaslighting , belittling, hoovering, and blame-shifting.

Narcissistic abuse can have profound and long-term effects on a person’s self-esteem, trust in others, and ability to form healthy relationships in the future.

To recognize the signs of narcissism in a partner, it is important to pay attention to their patterns of behavior. Some common characteristics of narcissistic abuse to be aware of include: excessive self-centeredness, a lack of empathy or concern for others, and a tendency to manipulate or control.

If you suspect you are experiencing narcissistic abuse, seeking support from friends, family, or a mental health professional is crucial.

It is important to recognize that breaking free from an abusive relationship and healing from its effects often requires time, patience, and self-compassion.

Narcissistic abuse can be detrimental to a person’s mental and physical health, self-esteem, and ability to form healthy relationships. Not all survivors of narcissistic abuse will experience the same effects, and individuals can heal and grow from their past experiences with the right support, therapy, and self-awareness.

The impact of the narcissistic abuse will often depend on a number of factors, including the severity and length of the abuse, the characteristics of the victim, and the level of support they have. 

Narcissistic abuse can occur in romantic relationships , among family members, between friends, or in the workplace.

No matter the case, it can lead to low self-esteem, anxiety, depression, post-traumatic stress disorder (PTSD), and difficulty forming healthy relationships.

What Are Some Effects of Narcissistic Abuse on Future Relationships?

The effects of narcissistic abuse on future relationships can be significant and complex. While these effects will vary among individuals, most will experience emotional detachment, trust issues, insecurity, and feelings of inadequacy.

Survivors are often left to question their perceptions, judgments, and sanity. They might blame themselves and carry this lack of self-worth into other relationships.

When working through your experiences, it is important to approach yourself from a place of compassion , patience, and understanding.

Below we will discuss some of the common effects of narcissistic abuse and provide some advice on how to cope with them. Additionally, seeking therapy or counseling can be instrumental in processing the trauma of narcissistic abuse and learning healthier ways to navigate future relationships.

Individuals can heal, grow, and escape the cycle of abuse with the right support, self-awareness, and professional help.

Trust Issues

It is common for individuals in abusive relationships to experience issues with trus t. When someone has experienced narcissistic abuse, they have likely been subjected to a pattern of deceit, infidelity, manipulation, and unpredictability.

As a result, they may develop deep-rooted trust issues that can profoundly impact their ability to form and maintain healthy relationships later in life.

At the beginning of a relationship, narcissists tend to portray false images of themselves to their partners. They come across as thoughtful, kind, and genuine. They might engage in love bombing , putting their partner on a pedestal and bombarding them with texts, calls, and gifts.

Narcissists also might put on a false front in familial relationships, with friends, or at work. They will act supportive and caring at first, but then quickly shift to being abusive and degrading.

This hot and cold behavior gives the victim a false sense of security and makes them question their own judgments and perceptions.

Ultimately, this can significantly impact a person’s ability to trust new people in the future. They might be constantly on guard, trying to assess whether the new person can be trusted or if they might exhibit similar abusive behaviors as their previous partner.

They may be skeptical of compliments or kind gestures, wondering if they are genuine or if they are part of a manipulative strategy.

Rebuilding trust is a gradual process that takes time and patience. It’s essential for survivors to be patient with themselves and their progress, and understand that with the right support, they can learn to rebuild trust in themselves and others.

Insecure Attachment

Growing up with narcissistic caregivers or being in a narcissistic relationship can significantly impact an individual’s attachment style, often leading to the development of an insecure attachment style .

Attachment theory suggests that our early experiences with caregivers shape our internal working models of relationships and affect how we bond, connect, and relate to others throughout life.

Individuals with an insecure attachment style often feel unsafe, anxious, and fearful in relationships. They lack trust and fear abandonment. As a result, they either become overly dependent on others, craving validation and reassurance, or they avoid relationships altogether.

Although attachment styles remain relatively stable throughout life, research has shown that it is possible to learn how to feel more secure in relationships over time (termed “earned secure attachment ”).

Healing from insecure attachment patterns and earning secure attachment is a gradual process. Here are some steps you can take to develop a more secure attachment:

• Education : Recognizing and understanding one’s attachment style is the first step toward healing. Educate yourself on attachment theory and different attachment styles so you can gain insight into how your past experiences have shaped your current attachment patterns.
• Therapy : Seeking therapy or counseling can be immensely beneficial in processing the trauma of a narcissistic relationship, addressing attachment issues, and learning healthier ways of relating to others.
• Developing Self-Worth : Building a positive self-image and greater self-esteem can help you feel more secure in relationships and less dependent on external validation.
• “Surrogate” Secure Attachment Figure: Having a role model, such as a partner, friend, or mentor who shows you how a securely attached person behaves and thinks, can be immensely beneficial.

Poor Decision-Making

Due to their past experiences, survivors might have difficulty making constructive, sound decisions. Narcissistic abuse can be detrimental to a person’s sense of self-worth and confidence. 

Victims may be left constantly questioning their own judgments and perceptions, blaming themselves for the abuse they have suffered.

Because narcissists would control all areas of their partners’ lives, including their finances, friendships, and social lives, victims were typically not allowed to make their own decisions.

As a result, their ability to make decisions for themselves once they are free from the relationship is often skewed.

In order to regain your confidence in your decision-making, you must first acknowledge that your thoughts, feelings, and needs are valid. 

By developing a strong sense of self-worth, survivors can learn to feel more secure in their relationships and less dependent on external validation.

People Pleasing

People pleasing is a behavioral pattern where an individual prioritizes meeting the needs and desires of others above their own, often to avoid conflict or confrontation.

People-pleasers have a strong desire to be liked, accepted, and approved of by others, leading them to go to great lengths to avoid conflict or disapproval. These individuals often have a low self-esteem, fear rejection, and crave validation from others.

Experiencing narcissistic abuse, especially as a child, often leads to people-pleasing behavior later in life. As a result, victims of abuse will seek constant reassurance from their partners or others to alleviate their anxiety and fears.

Therefore, building your confidence and assertiveness will help you to reduce your people-pleasing tendencies and allow you to maintain healthier relationships in the future.

Self-Destructive Habits

Narcissistic abuse can make you feel alone, destroy your confidence, and create an “empty” feeling within you. This distress can feel overwhelming.

For that reason, many survivors of narcissistic abuse will turn to self-destructive habits, such as drugs, alcohol, gambling, or sex, as a way to cope.

Additionally, they may push others away or sabotage new relationships to protect themselves from potential harm in the future.

Or, they might enter into relationships with people who engage in similar destructive behaviors, creating a vicious cycle of abuse.

Going to therapy or a support group (e.g., a 12-step program) can be helpful for dealing with the underlying causes of these self-destructive behaviors.

Loss of Self-Worth and Distorted Self-Image

Narcissistic abuse will completely destroy one’s sense of self. Narcissists want to control their environments and the people in them, so they seek to destroy their victim’s self-worth to gain this authority.

Unfortunately, these feelings of confusion and worthlessness will affect your ability to form healthy and stable relationships in the future. It can also lead to a number of other issues, such as poor mental health, deep-rooted insecurities , substance misuse, and impaired academic or job performance. 

Thus, regaining your sense of self and worth is crucial for your general well-being as well as the health of your future relationships.

A few tips for building self-worth:

• Write down your strengths and the things you love about yourself
• Start a gratitude diary
• Start small and work your way forward
• Practice saying “no”
• Challenge yourself to go out of your comfort zone (e.g. go to a restaurant or to see a movie alone)
• Have compassion and understanding for yourself
• See a therapist or attend a support group

How Can I Get Past My Fear and Trust Again After Narcissistic Abuse?                          

Recovering from the fear and rebuilding trust after narcissistic abuse can be a challenging journey. But, it is possible with time, self-compassion, reflection, and the right support.

Finding a therapist who has experience with narcissistic abuse or joining a support group for survivors of narcissistic abuse is highly recommended. 

Here are some tips that can help you on your healing journey:

• Cut off all contact with the narcissist. If this is not possible, limit contact as much as possible.
• Accept that the narcissist will not change. You should not waste any time or energy waiting for them to do so. Instead, focus on healing yourself.
• Make your well-being and recovery your priority. Allow yourself to feel anger, sadness, and any other emotions that may arise without judgment.
• Learn to say no when you feel uncomfortable or overwhelmed, and communicate your needs and limits in your relationships.
• Set and maintain clear boundaries with all the people in your life, regardless of whether they are narcissists or not. Establishing boundaries is crucial for regaining a sense of control and safety.
• Educate yourself about narcissism . Learning more about narcissism and its effects can help you gain insight into your experience and understand that the abuse was not your fault. This can also help you be aware of early signs of potential narcissistic behaviors or toxic patterns in new relationships.
• Be kind to yourself and practice self-compassion. Self-blame is common after experiencing narcissistic abuse. But, the reality is that you fell victim to someone with manipulative behavior. Recognize that your feelings and reactions were valid responses to the abuse you endured.
• Forgive yourself. Treat yourself with the same care and understanding you would offer a friend.
• Practice self-care. This might include exercise, journaling, meditation, therapy , or mindfulness – choose whatever makes you feel good.
• Be proactive about your recovery. Recognize and celebrate the progress you make in your healing journey. Each step you take towards healing and learning to trust again is a significant achievement.

Where Can I Get Help for Narcissistic Abuse?

If you or someone you know is experiencing narcissistic abuse and needs help, there are several resources available to provide support and assistance.

Seeking the help of a licensed therapist or counselor who specializes in trauma, abuse, or narcissistic relationships can be immensely beneficial. They can provide a safe and nonjudgmental space to process your experiences, explore your emotions, and develop coping strategies for healing and moving forward.

If the first therapist you find is not helpful, find another one – it can sometimes take a few tries to find the right person.

Additionally, there are a number of online resources, forums, and communities that can be worthwhile ( learn more about signs of narcissistic abuse here ). They might help you to gain a better understanding of narcissistic behavior, allow you to connect with others, and provide valuable resources and information.

Many countries also have domestic violence hotlines or helplines that offer support and resources for individuals experiencing abuse.

These helplines are staffed by trained professionals who can provide information, safety planning, and referrals to local support services.

Joining a support group for survivors of narcissistic abuse can also be valuable. Connecting with others who have had similar experiences can help you feel less isolated and provide validation and understanding.

Your safety and well-being are essential, and there are a number of resources and people ready to help you on your path to healing and recovery .

Frequently Asked Questions

Can you get ptsd from narcissistic abuse.

Yes, it is possible to develop PTSD as a result of experiencing narcissistic abuse.

PTSD is a mental health condition that can develop after a person has been exposed to a traumatic event or series of events. Narcissistic abuse can be traumatic because it undermines a person’s sense of self-worth, autonomy, and safety.

Some common symptoms of PTSD that may result from narcissistic abuse include:

Flashbacks Nightmares Intrusive thoughts Dissociation Emotional dysregulation Hypervigilance Trouble sleeping and concentrating Feeling guilty and ashamed

It’s essential to seek help and support if you suspect you are experiencing symptoms of PTSD.

A mental health professional, such as a therapist or counselor experienced in trauma and abuse, can provide appropriate assessment, validation, and therapeutic interventions to help you cope with the effects of the abuse and work towards healing and recovery.

What Does Narcissistic Abuse Do to the Brain?

Narcissistic abuse can have significant effects on the brain, resulting from the chronic stress, emotional manipulation, and trauma experienced during the abusive relationship.

Survivors of narcissistic abuse often develop hyper-vigilance, a state of heightened awareness and alertness, as a result of being constantly on guard for the abuser’s next emotional attack or manipulation. This is known as the fight/flight response . This state of chronic stress can lead to increased anxiety and changes in the amygdala, the brain’s fear center.

Narcissistic abuse can also disrupt the brain’s ability to regulate emotions. Some individuals might experience intense anger, fear, sadness, and shame, and have difficulty managing their emotions.

Others might experience dissociation, depression, and emotional numbing. This is a coping mechanism where the mind detaches from the immediate reality as a way of protecting you from the full impact of the experience.

Cognitively, many survivors’ belief systems are shattered by experiencing abuse. Chronic stress and trauma can impact memory and cognition. Survivors of narcissistic abuse may experience memory impairment and difficulty concentrating due to changes in the hippocampus and other brain regions involved in memory processing.

What Does Narcissistic Abuse Do to the Body?

Narcissistic abuse, like any other trauma, can have a detrimental impact on a person’s health. Prolonged stress and trauma can weaken the immune system, making the body more susceptible to infections, ailments, and illnesses.

Here are some ways narcissistic abuse can impact the body:

1. Gastrointestinal issues (e.g. irritable bowel syndrome (IBS), constipation, or diarrhea) 2. Increased heart rate, elevated blood pressure, and compromised immune function 3. Sleep disturbances 4. Headaches, migraines, or muscle tensions 5. Cardiovascular issues (e.g., chest pain, heart-related problems) 6. Respiratory issues (e.g. breathing difficulties, asthma) 7. Impaired cognitive function (e.g., difficulties with memory, concentration, and decision-making)

Can You Ever Recover From Narcissistic Abuse?

Recovering from narcissistic abuse takes time and patience, but it is possible.

While the effects of narcissistic abuse can be profound and long-lasting, with the right support, self-awareness, and healing work, individuals can gradually regain their sense of self, rebuild their lives, and form healthier relationships.

It’s essential to be patient, give yourself the space to heal at your own pace, and celebrate each step of progress you make along the way.

How Long Does It Take To Recover From Narcissistic Abuse?

The time it takes to recover from narcissistic abuse can vary significantly from person to person. Recovery is a complex and individualized process that depends on various factors, including the duration and intensity of the abuse, the survivor’s resilience, their support system, and their commitment to healing.

For some individuals, recovery may take several months, while for others, it could take years.

Each person’s journey is unique, and it’s okay to take the time needed to process emotions, understand the impact of the abuse, and rebuild a healthier sense of self and relationships.

Centre for Substance Abuse Treatment (2014). Trauma-informed care in behavioral health services. A treatment improvement protocol . Substance Abuse and Mental Health Services Administration (US).

Dansby Olufowote, R.A., Fife, S.T., Schleiden, C. & Whiting, J.B. (2019). How Can I Become More Secure? A Grounded Theory of Earning Secure Attachment. Journal of Marital and Family Therapy. 46 (3): 489-506.

Lauderdale, S. A., Martin, K. J., & Moore, J. (2019). Aversive indecisiveness predicts risks for and symptoms of anxiety and depression over avoidant indecisiveness. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 37(1), 62-83.

Levy, K.N, Ellison, W.D. Scott, N.S. & Bernecker, S.L. (2010). Attachment Style. Journal of Clinical Psychology, 67(2), 193-203. 

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Reviewed by Psychology Today Staff

Narcissists have a prominent place in the popular imagination , and the label "narcissist" is widely deployed to refer to people who appear too full of themselves. There's also a growing sense that narcissism is on the rise around the world, especially among young people, although most psychological research does not support that notion.

Narcissism is properly viewed on a spectrum. The trait is normally distributed in the population, with most people scoring near the middle, and a few at either extreme. The Narcissistic Personality Inventory (NPI), developed by Robert Raskin and Calvin S. Hall in 1979, is the most commonly used measure of the trait. Scores range from 0 to 40, with the average tending to fall in the low to mid-teens. Healthy individuals who score somewhat higher may be perceived as exceedingly charming, especially on the first encounter, but eventually come across as vain. Such individuals may have awkward or stressful personal encounters but still have a fundamentally healthy personality.

• The Traits of Narcissism
• How to Handle a Narcissist
• Narcissism in Relationships

It’s easy to describe someone who spends a bit too much time talking about her career or who never seems to doubt himself as a narcissist, but the trait is more complicated than that. Narcissism does not necessarily represent a surplus of self-esteem or of insecurity; more accurately, it encompasses a hunger for appreciation or admiration, a desire to be the center of attention , and an expectation of special treatment reflecting perceived higher status. Interestingly, research finds, many highly narcissistic people often readily admit to an awareness that they are more self-centered. A high level of narcissism, not surprisingly, can be damaging in romantic, familial, or professional relationships.

Narcissism is characterized by a grandiose sense of self-importance, a lack of empathy for others, a need for excessive admiration, and the belief that one is unique and deserving of special treatment. If you encounter someone who  consistently exhibits these behaviors,  you may be dealing with a highly narcissistic individual.

Pathological narcissism, or narcissistic personality disorder , is rare: It affects an estimated 1 percent of the population, a prevalence that hasn't changed since clinicians started measuring it. The disorder is suspected when narcissistic traits impair a person’s daily functioning. That dysfunction typically causes friction in relationships due to the pathological narcissist's lack of empathy . It may also manifest as antagonism, fueled by grandiosity and attention-seeking. In seeing themselves as superior, the pathological narcissist naturally views everyone else as inferior and may be intolerant of disagreement or questioning.

If you wonder whether someone is a narcissist, it might be best just to ask them. It’s generally assumed that people either don’t realize that they are narcissists, or deny it to avoid a challenge to their identity . But in research using the so-called Single-Item Narcissism Scale, people who answered affirmatively to the single question, “Are you a narcissist?” were far more likely than others to score highly on narcissism on the 40-question Narcissistic Personality Inventory.

Research has discovered some benefits in relatively high but subclinical narcissism, such as increased mental toughness (performing well in high-pressure situations) and higher achievement in school and on the job. A heightened sense of self-worth may also make a person more motivated and assertive than others. Other research has linked narcissism to a lower incidence of depression .

A narcissistic boss places getting ahead over getting along, which means they’re often uncollaborative, arrogant, and argumentative, and myopically focused on becoming “the winner.” Narcissistic bosses take all the credit for successes and lash out at those who do not demonstrate loyalty. These tendencies and others indicate that you may be dealing with a narcissistic boss.

Navigating a relationship with a narcissist can be deeply frustrating and distressing. In their quest for control and admiration, narcissistic people may manipulate and exploit others, damaging their self-esteem and even aiming to alter their sense of reality. Arguing with a narcissist about their action often proves fruitless. A more successful solution is to establish boundaries and emotionally distance yourself. Recognize that you may not be able to control your feelings about a person, but you can control how you respond to them. Cutting ties with a narcissistic partner, family member, or boss may eventually be the best if not the only solution. In that process, it's helpful to reflect on the characteristics of the individual to avoid finding oneself in similar scenarios in the future.

Acknowledging your frustration, appreciating where the behavior comes from, and refusing to lose your own sense of purpose when a narcissist takes center stage are key strategies, among others. Researchers who classify narcissists as either vulnerable or grandiose argue that specific approaches are warranted for each type.

Manage your expectations, align your successes with your boss’s, draw boundaries, and don’t try to argue, justify, or explain yourself. These and other tactics can help you navigate a narcissist in the workplace.

Narcissists tend to have an intense drive for power, attention, and affirmation, which may benefit them in campaigns for corporate management or political leadership . Once in charge, though, they may focus more on self-promotion and the suppression of opposition than advancing an organization’s goals and their lack of empathy fosters little loyalty.

A narcissist's desire to elicit admiration and praise, especially from potential romantic partners, often makes them charming and charismatic , traits that can rapidly ignite a romance. But their inherent deficit of empathy may prevent them from understanding a partner's inner world and establishing a fulfilling long-term relationship.

It's nearly impossible for people with narcissistic personality disorder to truly fall in love and build a trusting, equal partnership. Such an individual may seek to establish strict rules in a relationship and attempt to isolate a new partner from friends and family, among other disturbing behaviors .

Research suggests that people may initially be drawn to narcissists because they seem to possess stronger self-esteem than they really do, a trait that people often appreciate.

Narcissists may show passion and charm in the early stages of dating. But for most narcissists,  relationships are transactional.  They provide positive attention and sexual satisfaction to bolster a narcissist’s ego and self-esteem. The objective is to enjoy uncommitted pleasure, and most narcissists lose interest in the relationship as the expectation for  intimacy  increases or they feel that they’ve conquered the challenge of securing a relationship.

From an evolutionary perspective, it has been theorized that, at least in the realm of mating , narcissism may serve an adaptive function: increased success in short-term mating. Cross-cultural research has found that narcissists tend to have higher levels of sociosexuality: They are more interested in short-term relationships or hookups, and more likely to pursue partners who are already in committed relationships.

Narcissistic personality disorder is relatively rare—there are many more people who are simply selfish. The difference lies in whether the person is periodically mean and self-centered or whether they consistently lack empathy.

While most people's inner monologue is self-focused, narcissists' thoughts are externally-focused.

The exaggerated sense of entitlement seen in narcissism often begins in childhood with an over-indulgent parent "protecting" the child from experiencing the shame emotion.

It's dangerous to look at yourself through the narcissist’s distorted lens, but you may not realize it's skewed. It's like looking in a fun house mirror, not knowing it's warped.

Learn 10 vital strategies for raising emotionally healthy children (as opposed to narcissists).

When is the best time to stay quiet or end a conversation? When it could be counter-productive—like a heated conversation that is going nowhere.

A new streaming series, "Hollywood Con Queen," depicts a master manipulator who fooled hundreds of marks into enriching him at their expense.

The pressures of modern society create a paradox in which confidence and wealth often hide internal struggles.

Not all blunt talkers cut through with care.

3 ways to promote your spouse from supporting role to co-star.

As a society, we can do better than to use a severe personality disorder as a go-to insult to denigrate someone whose behaviors we are dissatisfied with.

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Exploring the Intersection of AI and Qualitative Research: A Comprehensive Overview

Discover how AI is impacting qualitative research in market studies, coding, and user persona development. Uncover the potential and challenges of AI in research.

Co-founder at ora.ai

The integration of Artificial Intelligence (AI) into the domain of qualitative research has opened up new areas of exploration, efficiency, and innovation. This blog post dives into recent academic research that sheds light on how AI, especially generative AI models like ChatGPT, are impacting qualitative research methodologies, offering insights into their capabilities, applications, and the challenges they pose.

Market Research With Generative AI

A study co-authored by scholars from Harvard Business School and Microsoft explores the potential of generative AI as a substitute for human participants in marketing studies. The paper underscores how generative AI can simplify the current market research process. The researchers conducted hundreds of survey simulations with Large Language Models (LLMs) to analyze consumer preferences .

The study showcases two significant findings: firstly, OpenAI GPT-3.5's responses align with economic theories and well-known consumer behaviors, such as displaying downward-sloping demand curves and state dependence. Secondly, the model's generated estimates for willingness-to-pay for products and attributes closely match those derived from human consumer surveys. This suggests that LLMs could serve as efficient, cost-effective alternatives to traditional market research methods, significantly reducing the time and financial resources required.

AI is Transforming Qualitative Research Coding

The research highlights LLMs’ adeptness at replicating nuanced human behavior patterns in market settings, showcasing their potential as a valuable tool for marketers. Despite the need for further exploration to refine these methodologies, this study opens the door to leveraging AI to gain insights into consumer behavior and preferences.

It suggests a future where generative AI not only augments but potentially reinvents the field of market research. However, the authors caution that while LLMs like GPT-3.5 show great promise, their capabilities and limitations need careful consideration to ensure their outputs are reliable and applicable in real-world scenarios.

Enhancing Qualitative Coding

QualiGPT is a tool designed to tackle the challenges posed by ChatGPT in qualitative analysis. QualiGPT emerges as a possible solution that streamlines the coding process in qualitative research. By facilitating a more efficient analysis process, QualiGPT could be a potential improvement in making qualitative research more accessible and manageable. Developed by researchers from Penn State University, it’s a specialized toolkit to navigate the intricacies of qualitative data analysis through the application of LLMs.

Qualitative research often finds itself slowed down during the critical coding phase, necessitating a significant amount of time and meticulous effort. Traditional software platforms designed for qualitative evaluation have struggled to meet the demands for automatic coding, intuitive usability, and cost-effectiveness.

However, the emergence of Large Language Models such as GPT3 and its successors might create new opportunities for increased efficiencies in qualitative analysis. By employing a comparative approach that juxtaposes traditional manual coding with QualiGPT’s analysis on both simulated and real datasets, the study is able to validate the hypothesis that the application makes qualitative analysis more efficient. QualiGPT might already be a valuable tool for researchers today, offering a glimpse into a future where the integration of AI in qualitative research enables new ways of understanding, interpreting, and processing qualitative data.

Automating Research with AI Agents

Through a comprehensive set of tasks, this Stanford study assesses AI research agents on their ability to execute actions like outcome analysis, thereby simulating a real-world research environment.

A highlight of this study is the implementation of an AI research agent built upon GPT4, showcasing the agent's potential to generate competitive models across various tasks autonomously. The agent demonstrates remarkable adaptability, formulating dynamic research plans and executing a series of interpretable actions toward achieving the set objectives.

Nonetheless, the success rates exhibit significant variability, ranging from nearly 90% in well-established datasets to as low as 0% in newer research challenges. The paper outlines several challenges faced by LLM-based research agents, such as long-term planning and the tendency to generate hallucinated data or conclusions (referred to as "hallucination" in AI parlance). Despite these hurdles, the research introduces a structured path toward enhancing the capabilities of AI agents in automating research, opening up avenues for further advancements in this domain.

AI-Enabled User Persona Development

A study by Stefano De Paoli from Abertay University dives into the use of GPT3.5 for conducting Thematic Analysis (TA) of semi-structured interviews to develop user personas. This research presents a novel approach to qualitative data analysis, extending beyond conventional coding and theme generation to the synthesis of complex user personas. De Paoli's work illustrates the LLMs’ capabilities to engage in the final phase of TA (writing up the results). 

The study successfully demonstrates that LLMs can generate user personas that are both coherent and relevant, based on themes derived from interview data, thereby offering a methodological innovation in the creation of user personas for User-Centered Design processes. This could be a substantial leap forward in the application of AI for qualitative research, showcasing the potential for AI to not just complement but also participate in the more creative aspects of qualitative analysis.

The intersection of AI and qualitative research is witnessing an exciting phase of innovation and exploration. As highlighted through recent academic studies, AI (especially generative models like GPT4) is proving to be a valuable asset in enhancing the efficiency, depth, and scope of qualitative methodologies. From automating market research and coding processes to generating user personas and facilitating autonomous research tasks, LLMs are expanding the horizons of what's possible in qualitative research.

However, these advancements come with their own set of challenges, including issues related to bias , reliability, and trust. Despite these hurdles, the integration of AI into market research is heading towards a future where the synergy between human ingenuity and AI efficiency can lead to richer, more nuanced understandings of complex (user) behaviors and patterns. The journey ahead involves navigating these challenges with ethical responsibility and a commitment to methodological rigor, ensuring that AI serves as a complement to rather than a replacement for the value of human analysis in qualitative research.

The views, opinions, data, and methodologies expressed above are those of the contributor(s) and do not necessarily reflect or represent the official policies, positions, or beliefs of Greenbook.

Comments are moderated to ensure respect towards the author and to prevent spam or self-promotion. Your comment may be edited, rejected, or approved based on these criteria. By commenting, you accept these terms and take responsibility for your contributions.

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The 10 Darkest 'South Park' Episodes of All Time, Ranked

The town of South Park has seen some really dark stuff.

South Park prides itself on being offensive, confronting, and going to dark places. Of course, it does this better than most adult animated shows, as South Park is, first and foremost, a satire of life and popular culture. But even amongst its own content, some episodes stand out in their darker tone above others.

They deal with extreme character choices, take a more serious stance on a specific subject matter, and discuss topics more confronting for a mainstream audience. Of course, it’s mostly all down with the classically cynical sense of humor South Park is known for. But sometimes, even South Park goes to darker places than expected, with some of its most disturbing episodes often being its best or most controversial .

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10 "The Return of Chef"

Season 10, episode 1 (2006).

After Isaac Hayes left the show, the character of Chef had to be retired, and it’s as tragic a retirement if there ever was one. Chef returns to South Park after spending some time traveling with the Super Adventure Club. The boys find that Chef has changed dramatically, talking weirdly and expressing unsavory desires for them.

They go to the Super Adventure Club, only for them to reveal they’ve brainwashed him to follow their evil practices. When they try to save him, Chef ends up being struck by lightning, set on fire, jagged by rocks, and mauled by mountain lions. It’s a legitimately sad and horrifying end for such a beloved character to go out on , making it an emotional South Park moment no fan will soon forget.

9 "Woodland Critter Christmas"

Season 8, episode 14 (2004).

Out of all the Christmas specials South Park has produced over the years, this one is easily their darkest and best yet. A few days before Christmas, Stan finds a group of talking woodland critters making a tree. They’re excited because Porcupiney the Porcupine is going to give birth to their savior. But what begins as wholesome fun soon descends into hell – especially since the critters are actually Satan worshippers.

They discover Kyle is the perfect vessel to ingest the Anti-Christ’s spirit and usher in a new era of darkness. Now Stan must stop them with the help of a group of orphaned cubs and a gun-toting Santa Claus. Not a conventional Christmas by any means, and certainly a dark offering from South Park .

8 "Britney’s New Look"

Season 12, episode 2 (2008).

"Britney’s New Look" is the rare episode revolving around a celebrity that seems to take pity on them rather than mock them. A new piece about Britney Spears appears to be hitting the airwaves of South Park every day, and Stan & Kyle decide to get a photo of her to sell for cash.

But the more time they spend with her, the more they realize she’s desperate to escape the press, which soon escalates to comically unhinged levels . As the episode continues, Britney is pushed to the limit, literally blowing half her head off, and eventually photographed to death by the paparazzi as part of an ancient sacrifice.

7 "Butter's Very Own Episode"

Season 5, episode 14 (2001).

Butters’ parents have shown themselves as terrible people before, but "Butters’ Very Own Episode" brought them down to a new low . In what many consider to be the best Butters episode in South Park , after discovering her husband’s seeming infidelity, Butter’s mom tries to drown him inside a car in the river in grief-induced hysteria.

Once she calms down and realizes what she’s done, the two lie to the press and claim their son was abducted. Little do they know that Butters survived and is borderline oblivious to his parents’ terrible behavior. Butters seems to have a knack for falling into traumatizing situations that shatter his innocence.

6 "Kenny Dies"

Season 5, episode 13 (2001).

Until this point in the series, Kenny would die in almost every episode and return the following week without explanation, making it almost an expected running gag for any fan. But in the episode "Kenny Dies," he is faced with a terminal illness and is played straight dead , seemingly forever.

The rest of the boys have their distinct reactions – Kyle stays in the hospital to be by Kenny’s side, Stan refuses to see him out of grief, and Cartman decides to profit off it to lift a ban on stem cell research. Thankfully, and after much backlash from viewers, Kenny came back a year later and has remained alive since.

5 "Stanley's Cup"

Season 10, episode 14 (2006).

After Stan’s bike is towed away, he’s stuck coaching a hockey team for little kids. One of the kids, Nelson, has a terminal illness, and only a win against the Detroit Red Wings can be enough to save his life. Unfortunately, the team is not precisely well-trained for playing in the big leagues.

Of course, audiences expect sports stories like "Stanley’s Cup" to end with the team winning and the illness being beaten or mitigated. Instead, it ends on a decidedly cruel note that may be uplifting for one team but is utterly devastating for another . It's another fantastic example of South Park parodying genres in hilarious ways.

4 "Cartman Joins NAMBLA"

Season 4, episode 5 (2000).

In a characteristic display of narcissism, Cartman decides his regular friends aren’t “adult” enough for him anymore. So he decides to find some adult friends on the internet, only to run afoul of a group called NAMBLA eventually. The group invites the boys to hang out at a hotel, but it’s apparent the members don’t exactly have their best interests at heart.

Meanwhile, Kenny finds out that his mom and dad are trying for another baby, and he tries everything he can to ensure that the baby isn’t conceived . The two plots collide in a cavalcade involving Marlon Brando lookalikes, a Scooby-Doo -esque chase through the hotel, and Kenny’s dad needing a hot bath.

3 "Crack Baby Athletic Association"

Season 15, episode 5 (2011).

In a typically evil Cartman scheme, he, Butters, Craig, and Clyde have decided to form the Crack Baby Athletic Association. For this new company, they film drug-addicted babies fighting each other and post their videos online. Soon they become ridiculously popular, as they receive offers from EA Sports to make a video game out of them.

While horrified by Cartman’s actions, Kyle directly participates in the schemes, causing conflicting feelings to arise. Unfortunately, the happy ending the boys receive still doesn’t entirely diminish the shock that they’ve used babies’ drug addictions for profit . Audiences who had to sit through that one were also likely left scratching their heads.

2 "HumancentiPad"

Season 15, episode 1 (2011).

When it comes to traumatizing events faced by the boys, Kyle is only second to Kenny in exposure. But no South Park episode has put Kyle through a worse predicament than in "HumancentiPad," which references the gross horror movie The Human Centipede . One day, he downloads his latest iTunes update but makes a near-fatal mistake when he does not read the terms and conditions.

Once Steve Jobs and his Apple agents capture him, he is forced into a horrific punishment right out of The Human Centipede , which is jarring to watch in the animated show. In the end, the only happy note the episode ends on is when Cartman is struck by lightning after angering God, which is arguably not as bad as the actual punishment he deserves.

1 "Scott Tenorman Must Die"

Season 5, episode 4 (2001).

"Scott Tenorman Must Die" marked a turning point in Cartman’s character from a racist bully to a borderline psychotic supervillain disguised as a kid. In this episode, he finds himself a target of pranking and bullying by teenage punk Scott Tenorman. No matter what Cartman tries to do for payback, Scott always seems to be one step ahead.

In perhaps Cartman’s most evil action to date, he decides to take a page out of Titus Andronicus’ book. Cartman has Scott’s parents killed, makes them into chili, and feeds it to a horrified Scott for a final act of revenge. The darkly comedic moment has since earned a reputation for being one of the show's most controversial and darkest moments.

NEXT: The Best 'South Park' Episodes of All Time, Ranked According to IMDb