When someone is high narcissism what type of data about this person might be the least trustworthy?

Abstract

Narcissistic personality disorder, NPD, by now a recognized psychiatric condition, has been extensively studied over the past century, but remains challenging both to diagnose and treat. At present, studies within different theoretical and empirical approaches, i.e., psychoanalytic, attachment focused, metacognitive, personality psychological, and neuroscientific, are contributing to advancing the definition and understanding of pathological narcissism and narcissistic personality functioning. This article will provide an overview of some of the latest advances in identifying and differentiating the prime characteristics for NPD in terms of regulation of self and agency, self-esteem, affects, and interpersonal relatedness. NPD focused treatment modalities will be reviewed.

Results and Comments

The NPI-16 continues the NPI tradition of measuring the grandiose version of narcissism using forced-choice items. The instrument is remarkable in its ability to reproduce results similar to those with the full 40-item version. However, an even newer version, the NPI-13, has produced a more balanced factor structure while retaining comparable validity to the NPI-16 (Gentile et al., 2013).

NPI-16 Sample Items

The format retained the original NPI format, that is, dichotomous forced-choice items.

I like to be the center of attention vs. I prefer to blend in with the crowd.

I think I am a special person vs. I am no better nor worse than most people.

Note: Reproduced with permission.

Differentiating High Self-Esteem from Narcissism

Narcissism is a personality trait that is often confused with high self-esteem and so bears mention here. Although its conceptualization shares historical origins with ‘Narcissistic Personality Disorder (NPD),’ and its most common measure (the Narcissistic Personality Inventory; Raskin and Terry, 1988) was based on the NPD diagnostic criteria, narcissism varies on a continuous dimension in the general population – it is often called subclinical or ‘normal narcissism’ (Sedikides et al., 2004). Narcissism entails a grandiose, inflated self-image and desire for power, coupled with a sense of entitlement and lack of regard for others (Campbell and Foster, 2007). When people describe high self-esteem using words like ‘arrogant’ and ‘show-off,’ they are more accurately describing high narcissism. That is, high self-esteem involves feeling comfortable with oneself and equal to others, whereas high narcissism involves feeling grandiose and superior to others. One concerning consequence of this confusion is that educational programs that grew out of the ‘self-esteem movement’ may inadvertently have promoted narcissism: some evidence suggests that narcissism levels are rising generation by generation (Twenge et al., 2008).

Narcissism shares parallels with fragile high self-esteem. Indeed, narcissism correlates moderately with global self-esteem, but also with indices of defensiveness. For example, high-narcissists (but not high-self-esteem individuals) are preoccupied with maintaining their positive self-views and use self-enhancement and self-protection strategies that are publicly visible or derogate others (Hepper et al., 2010). They have sometimes, but not always, been found to have more unstable self-esteem, low implicit self-esteem, or self-esteem that is contingent upon competition (Rhodewalt, 2012). However, narcissism is a multifaceted personality trait and is more than just fragile high self-esteem. In particular, narcissists are especially motivated by concerns about agency and do not care about communion; interpersonal entitlement is a core feature of their attitude to others. This personality structure explains narcissists’ frequent success in business, coupled with their difficulties in close relationships, in ways that their fragile high self-esteem cannot (Campbell and Foster, 2007). There is evidence that high global self-esteem accounts for narcissists’ high satisfaction with life and low loneliness, perhaps buffering their well-being from their interpersonal difficulties (Sedikides et al., 2004). Thus, the constructs overlap but are distinct.

Narcissistic personality disorder

Narcissistic personality disorder (NPD) is primarily characterized by unwarranted feelings of self-importance and entitlement, but it is also defined as including an unwillingness to empathize with the feelings and needs of other people. Relatively little empirical investigation of this assumption has been carried out. However, the pattern suggested by the existing evidence is that those with an NPD diagnosis do appear to be less emotionally responsive to others' experiences, but appear to have few deficiencies in their ability to engage in perspective taking, provided they are motivated to do so (e.g., Ritter et al., 2011). This conclusion is also consistent with evidence from investigations that have used a trait measure of narcissism rather than clinical diagnoses.

Narcissistic Personality Disorder

Narcissistic personality disorder (NPD) is primarily characterized by unwarranted feelings of self-importance and entitlement, but it is also defined as including an unwillingness to empathize with the feelings and needs of other people. Surprisingly, little empirical investigation of this assumption has been carried out. However, the pattern suggested by the existing evidence is that those with an NPD diagnosis do appear to be less emotionally responsive to others’ experiences. But, they appear to have no deficiencies in their ability to engage in perspective taking, although they may have lower motivation to do so (e.g., Ritter et al., 2011). This conclusion is also consistent with evidence from investigations that have used a trait measure of narcissism rather than clinical diagnoses.

Narcissistic Personality Disorder

Narcissistic personality disorder (NPD) was new to the third edition of the APA (1980) diagnostic manual. It has not been included within the World Health Organization’s (1992) International Classification of Diseases as it has been perceived internationally as largely an American concept (Ronningstam, 2005). NPD was proposed for deletion in DSM-5, due in part to the perception that there was little credible research (Skodol, 2012). However, there is a considerable body of empirical research on narcissism that is directly relevant to the validity of the NPD diagnosis (Miller et al., 2010; Ronningstam, 2005). The DSM-5 Workgroup eventually rescinded their proposal for its deletion.

NPD is a pervasive pattern of grandiosity, need for admiration, and lack of empathy (APA, 2013). Persons with NPD are quite vulnerable to threats to self-esteem. They may react defensively with rage, disdain, or indifference but are in fact struggling with feelings of shock, humiliation, and/or shame (Miller et al., 2010). The APA diagnostic criteria include a grandiose sense of self-importance; arrogance; a preoccupation with fantasies of success, power, or brilliance; a sense of entitlement; a lack of empathy; interpersonal exploitation; and a need for excessive admiration (APA, 2013).

There has been some concern that the DSM-5 criterion set places too much emphasis on a grandiose narcissism, which is often associated with success in work and career, failing to adequately recognize a vulnerable narcissism suggested by feelings of vulnerability, humiliation or rage in response to criticism or rebuke, shame, need for admiration, and self-devaluation (Pincus and Lukowitsky, 2010). It is suggested that narcissistic persons fluctuate between states of grandiosity and vulnerability. This may indeed be the case but there is, as yet, little research to support this belief.

NPD is also one of the more difficult PDs to assess, as persons are unlikely to acknowledge being arrogant, boastful, or hypersensitive to rebuke, failure, or criticism. Narcissistic persons tend to perceive themselves as being extraverted, popular, and engaging, whereas others will perceive them as being arrogant and conceited (Oltmanns and Lawton, 2011).

DSM-5 NPD is diagnosed more frequently in males (APA, 2013). Persons with this disorder might be seemingly well adjusted and even successful as a young adult, having experienced substantial achievements in education, career, and perhaps even within relationships. However, relationships with colleagues and friends become strained over time as their lack of consideration for others, self-serving promotion, infidelity, and even exploitative use of others becomes cumulatively evident (Miller et al., 2010).

There is empirical support for the heritability of NPD (South et al., 2012) but it is not clear what precisely is being inherited. There is quite a bit of clinical speculation as to the psychosocial etiology. One hypothesis that does have some empirical support is that there has been an excessive idealization by parental figures (Horton, 2011). Another theory suggests that devaluing parental figures have failed to adequately nurture a child’s natural need for positive regard. Such a child may find that the perceived love of a parent is contingent largely on achievements or successes. However, there is little systematic research to support this theory (Horton, 2011).

Conflicts and deficits with respect to self-esteem are considered to be central to the pathology of the disorder (Ronningstam, 2005). Narcissistic persons seek and embrace signs and symbols of recognition to compensate for conscious or perhaps even unconscious feelings of inadequacy. Narcissism is not simply arrogant self-confidence, as it can be more highly correlated with instability in self-esteem than with a consistently high self-confidence (Wallace, 2011).

Persons rarely seek treatment for their narcissism perhaps because they may not feel as though they are functioning poorly. Individuals with NPD enter treatment-seeking assistance for another mental disorder, such as mood disorder (secondary to career setback), substance abuse (often secondary to career stress), or some other form of psychopathogy, such as pathological gambling. There are few empirical studies on the treatment of narcissism, although much has been written on the basis of clinical experience.

Narcissism

Narcissism can be either a healthy or a pathological trait. Some narcissistic tendencies (e.g., leadership, self-absorption, superiority) can be functional and adaptive, enhancing an individual’s confidence and self-esteem. Other narcissistic tendencies (e.g., exploitiveness) are negative and deemed to be pathological. There is some evidence that more narcissistic individuals are more positive about their physical appearance, fitness, and sexual appeal. Furthermore, they are more invested in their physical appearance (both the benign and more pathological type of investment), and report more appearance-enhancing behaviors than less narcissistic individuals and less desire to change their physical appearance. Narcissism does not, however, appear to be related to evaluation or investment in health.

Abstract

Antisocial and narcissistic personality disorders are forms of persistent maladaptive personality styles that interfere with a person's functioning. Antisocial personality disorder is characterized by a disregard for the rights of others often exemplified by criminal behavior and a lack of remorse. Narcissistic personality disorder is characterized by a grandiose sense of self and pathological self-centeredness. Antisocial and narcissistic personality disorders often co-occur with one another and with other personality disorders and substance use disorders. The causes of antisocial and NPDs include both genetic and environmental influences. Success in treating these disorders often proves difficult.

Epidemiology

For narcissistic personality disorder, lifetime rates are estimated at 1% in the general global population, but between 2% and 16% in the clinical population. The rates in the United States are the same. In 2010, a review found rates of this disorder of up to 6% in various community samples, with males being slightly more affected than females. A 2015 review found that rates were relatively stable between males and females over a 30-year period of data collection. The lifetime prevalence of narcissistic personality disorder is highest in African-Americans between the ages of 20 and 29, with males having the highest rates (19.5%), and females slightly lower (14.5%). The lowest rates, within the same age group, are in Caucasian males (9.7%) and females (6.3%). However, with aging, the absolute lowest rates of narcissistic personality disorder are in people over age 65, with Asian-American males at 1.3% and females at 1.4%.