Many Faces of Narcissism (1):

Exploring Subtypes in the Narcissism Spectrum (NS)

Narcissism is a personality trait. Most (all?) people have this trait but to a varying degree. Healthy narcissism is about self-love without being self-absorbed, i.e., individuals with healthy narcissism can prioritise their own needs while still caring for others.  

Like autism, narcissism is on a spectrum. A certain amount of it is healthy. However, taken to an extreme, narcissism becomes pathological, i.e., the Narcissism Spectrum (NS) goes from ‘healthy narcissism’ to ‘pathological narcissism’ and Narcissistic Personality Disorder (NPD). The Narcissism Spectrum Model synthesises personality, social–psychological, and clinical evidence, building on existing knowledge about narcissistic grandiosity and vulnerability to reveal a view of narcissism that respects its clinical origins, embraces the diversity and complexity of its expression, and reflects extensive scientific evidence about the continuity between normal and abnormal personality expression (Krizan, Herlache 2018). 

Self-awareness and interpersonal relationships in NPD

Deficiencies in self and interpersonal functioning are fundamental characteristics of personality disorders. Clinical studies have shown that individuals with pathological narcissism and NPD often struggle with impaired self-awareness and distorted perceptions of others. Lukowitsky & Pincus (2013) conducted a research study to investigate the interpersonal perceptions of individuals with pathological narcissism. Their findings indicated that individuals high in pathological narcissism had some awareness of how peers would rate them but believed that others would rate them similarly to how they rated themselves. This suggests a complex interplay between self-awareness and interpersonal relationships in individuals with NPD.

Variety of manifestations and severity

Diagnostic confusion surrounding NPD reflects the disorder’s highly variable presentation and the wide range of severity that can characterise narcissistic pathology. Individuals with NPD 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 (Caligor, Levy, Yeomans 2015). People with NPD also typically show such extreme behaviours as: intensely emotional or unpredictable behaviour; distorting facts and making false accusations; using psychological manipulation (gaslighting), public shaming, and aggression.

Researchers have identified various subtypes of NPD that can manifest in different ways. Understanding these subtypes can provide deeper insight into the complexities of narcissistic personality traits and help in the development of effective interventions and treatments.

Subtypes of NPD

The contemporary conceptualisation of pathological narcissism (NPD) aligns with a history of clinical theorists who have delineated a dichotomy in the clinical presentations of narcissism, ranging from Kohut's and Kernberg's theories to other conceptualisations such as thick-skinned/thin-skinned (Rosenfeld 1987) and oblivious/hypervigilant (Gabbard 1989).

Russ et al. (2008) identified three subtypes of NPD: grandiose/malignant, fragile, and high-functioning/exhibitionistic. The core features of NPD included interpersonal vulnerability, underlying emotional distress, anger, difficulty in regulating affect, and interpersonal competitiveness. (Interestingly, these features were not included in the DSM-IV description of NPD.) A more comprehensive and nuanced perspective on NPD, as suggested by this study, could have significant implications for treatment and may help bridge the gap between empirical research and clinical understanding of the disorder.

The problem is that the concept of narcissism is defined inconsistently across various fields, such as clinical theory, social-personality psychology, and psychiatric diagnosis. This lack of consistency poses challenges in integrating research and clinical findings related to NPD. Two main issues have been identified that hinder this integration: the ambiguity surrounding the differentiation between pathological narcissism and normal narcissism, and the limited scope of existing measures of narcissism.

To address these challenges, four studies have been conducted to develop and validate the Pathological Narcissism Inventory (PNI). The PNI is a 52-item self-report tool designed to assess seven dimensions of pathological narcissism, including issues related to narcissistic grandiosity (such as entitlement rage, exploitativeness, grandiose fantasy, and self-sacrificing self-enhancement), and narcissistic vulnerability (including contingent self-esteem, hiding the self, and devaluing).

Results have shown that the PNI is negatively correlated with self-esteem and empathy, and positively correlated with shame, interpersonal distress, aggression, and borderline personality organisation. The grandiose scales of the PNI are associated with vindictive, domineering, intrusive, and overly-nurturant interpersonal problems, while the vulnerable scales are linked to cold, socially avoidant, and exploitable interpersonal issues. The PNI scales have demonstrated significant associations with parasuicidal behaviour, suicide attempts, homicidal ideation, and various aspects of psychotherapy utilisation. These findings highlight the importance of using comprehensive measures like the PNI to better understand and assess pathological narcissism in clinical settings (Pincus et al 2009).

Two distinct phenotypes of NPD

Theory and research have consistently shown that pathological narcissism can best be described by two distinct phenotypes, narcissistic grandiosity and narcissistic vulnerability (proposed by Pincus et al. 2009).

Cain et al. (2021) examined the specific types of interpersonal problems reported by those high in narcissistic grandiosity and high in narcissistic vulnerability and found that narcissistic grandiosity was associated with one distinct interpersonal profile, for example, being overly intrusive in relationships with others, while narcissistic vulnerability was associated with a wider range of interpersonal problems on the interpersonal circumplex such as three interpersonal subtypes associated with narcissistic vulnerability: an intrusive subtype, a cold subtype, and a socially avoidant subtype. Further examination of group differences showed that the three interpersonal subtypes associated with narcissistic vulnerability could also be distinguished based on their experience and expression of anger. This suggests the importance of assessing profiles of interpersonal functioning and anger in narcissistic vulnerability.

Narcissistic grandiosity and narcissistic vulnerability differ in terms of both subjective experiences and external behavioural manifestations (Lingiardi & Gazzillo, 2014; Pincus & Lukowitsky 2010; Ronningstam 2009):

Narcissistic grandiosity (overt narcissism) is characterised by traits commonly associated with NPD, including an exaggerated sense of self-importance, a need for constant admiration, arrogant, aggressive, and exploitative behaviours, lack of empathy, attention-seeking behaviours, self-serving beliefs of grandiose self-importance, and grandiose fantasies.

Individuals with overt narcissism may perceive themselves as more emotionally intelligent than they actually are. (Zajenkowski et al. 2018). They believe that they are superior to others and may engage in manipulative behaviours to maintain their perceived sense of power and control. They may also exhibit a sense of entitlement and expect special treatment from others. From dominating conversations to belittling others, grandiose narcissists love to be the centre of attention. They might struggle to notice the faults in their behaviours.

These individuals also may be focused on specific personal features and may directly link their self-worth to their physical attractiveness. They may be overbearing, extroverted, social, egotistic, and excessively competitive (Brookes 2015). This subtype is associated with more overt and aggressive narcissistic behaviours.

In contrast, narcissistic vulnerability (covert narcissism) encompasses traits and themes less commonly associated with the typical narcissistic patient. Individuals exhibiting vulnerability may display hypersensitivity to criticism and failure, avoidant and inhibited social behaviour, perfectionism, and intense feelings of shame and guilt.

Spotting someone who has covert narcissism can be tricky because they often try to make themselves look like the victim when they've actually hurt someone else. These individuals might try to make others feel bad, blame them for things, and manipulate them just to get attention and validation. Vulnerable narcissists might even try to make it seem like other people are the ones causing problems when really it is them. They can be sneaky by using tactics like gaslighting and lying.

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There is ongoing debate within the field regarding the relationship between these two phenotypes: are they opposing ends of a spectrum or distinct types of personality pathology with unique early life experiences, temperaments, and etiopathogenesis? Do these dimensions fluctuate within the same individual over time or do they tend to remain relatively stable? Furthermore, differences between these two phenotypes in terms of potential etiology, dysfunction in social and interpersonal domains, engagement in the therapeutic process, adherence to treatment, prognosis, and psychiatric comorbidities have been documented (Broglia et al. 2023).