thesis statement about narcissism

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The “Why” and “How” of Narcissism: A Process Model of Narcissistic Status Pursuit

Stathis grapsas.

1 Department of Developmental Psychology, Tilburg University

Eddie Brummelman

2 Research Institute of Child Development and Education, University of Amsterdam

Mitja D. Back

3 Department of Psychology, University of Münster

Jaap J. A. Denissen

We propose a self-regulation model of grandiose narcissism. This model illustrates an interconnected set of processes through which narcissists (i.e., individuals with relatively high levels of grandiose narcissism) pursue social status in their moment-by-moment transactions with their environments. The model shows that narcissists select situations that afford status. Narcissists vigilantly attend to cues related to the status they and others have in these situations and, on the basis of these perceived cues, appraise whether they can elevate their status or reduce the status of others. Narcissists engage in self-promotion (admiration pathway) or other-derogation (rivalry pathway) in accordance with these appraisals. Each pathway has unique consequences for how narcissists are perceived by others, thus shaping their social status over time. The model demonstrates how narcissism manifests itself as a stable and consistent cluster of behaviors in pursuit of social status and how it develops and maintains itself over time. More broadly, the model might offer useful insights for future process models of other personality traits.

Grandiose narcissism (hereafter: narcissism) is a personality trait marked by beliefs of personal superiority and a sense of entitlement to special treatment ( Krizan & Herlache, 2018 ; Morf & Rhodewalt, 2001 ). Narcissists (i.e., individuals with relatively high levels of grandiose narcissism) tend to go out of their way to impress others: They often groom their appearance to grasp others’ attention ( Back, Schmukle, & Egloff, 2010 ), brag about themselves ( Buss & Chiodo, 1991 ), and showcase their talents and abilities in front of others ( Wallace & Baumeister, 2002 ). At the same time, narcissists are often combative toward others. In such instances, they are often perceived as confrontational, insulting, belittling, and intimidating ( Holtzman, Vazire, & Mehl, 2010 ; Morf & Rhodewalt, 1993 ; Reijntjes et al., 2016 ).

What ties together these distinct manifestations of narcissism? Specifically, what is it that narcissists pursue (the “why” of narcissism) and how do they pursue it (the “how” of narcissism)? In this article, we propose a framework that addresses both the why and the how of narcissism. Drawing insights from evolutionary and motivational accounts of behavior, we propose that narcissism is rooted in a desire for social status. Drawing from self-regulatory processing models of personality in general and narcissism in particular, we propose that narcissism is manifested in sequences of status-pursuing processes.

Combining both perspectives, we propose a process model of narcissism, the status pursuit in narcissism (SPIN) model. The SPIN model posits that narcissists are driven by a dominant status motive, meaning that it overshadows other motives, such as the motive for affiliation. To fulfil this motive, narcissists engage in a series of status-pursuing processes: situation selection, vigilance, appraisal, and response execution. The model explains when narcissists engage in self-promotion (i.e., attempts to increase their own status) or other-derogation (i.e., attempts to decrease others’ status). The model demonstrates how narcissism manifests itself as a stable and consistent cluster of behaviors in pursuit of social status and how it develops and maintains itself over time.

Status Pursuit

Hierarchies are omnipresent in social settings and essential for group survival. They establish order and coordination and prevent intragroup conflicts because they dictate group members’ priority in social influence, access to resources, and mating opportunities ( Cheng, Tracy, Foulsham, Kingstone, & Henrich, 2013 ). Hierarchies emerge in social transactions: Groups compare members’ competence in domains useful for group survival and welfare (e.g., successful amassment of wealth or knowledge, higher intellect, or physical prowess; see Aunger & Curtis, 2013 ; Berger, Cohen, & Zelditch, 1972 ; Mattan, Kubota, & Cloutier, 2017 ) and bestow differing amounts of social status (or simply: status) to these members. Status is the amount of prominence, respect, and influence an individual has in a social group. It is indicative of a person’s position within a social hierarchy ( Anderson, Hildreth, & Howland, 2015 ).

Because hierarchies offer higher benefits for individuals closer to their top, people are assumed to be fundamentally motivated to pursue status ( Anderson et al., 2015 ; Barrick, Mount, & Li, 2013 ; Cheng et al., 2013 ; Mattan et al., 2017 ). Fundamental motives are universal, higher-order goals that are nonderivative of other goals, arise early in development, shape longer-term well-being, and can be satisfied across diverse contexts ( Anderson et al., 2015 ; Dweck, 2017 ).

As status is comparative and relies on the judgments of others, it is never guaranteed and always potentially malleable. Status pursuit is hence a continuous process rather than a one-off endeavor. Individuals differ markedly in how they tend to pursue status (for an overview of personality traits related to status pursuit and attainment, see Grosz, Leckelt, & Back, 2020 ). They differ in the absolute strength of their status motive, the relative strength of their status motive, and the rigidity of their status-pursuing actions. Some individuals are satisfied with having an average level of status, whereas other individuals want ever more ( Anderson et al., 2015 ; McClelland, 1987 ). Some individuals want status as long as it does not go against their motive to get along well with others (i.e., affiliation motive; Baumeister & Leary, 1995 ; McClelland, 1987 ), whereas other individuals want status even at the cost of getting along well with others. Some individuals pursue status in context-sensitive ways (e.g., boasting about themselves only in contexts that demand for such self-promotion), whereas other individuals pursue status rigidly (e.g., boasting about themselves, even in collaborative, interdependent contexts). We argue, on the basis of the tenet that individual differences in motivation can build the core of individual differences in personality traits ( Denissen & Penke, 2008 ), that individual differences in status pursuit are at the heart of individual differences in narcissism.

Narcissistic Status Pursuit

Narcissism is defined here as an everyday personality trait characterized by a sense of heightened self-importance and entitlement to special treatment ( Krizan & Herlache, 2018 ). Various features of narcissism have been discussed in the literature, ranging from agentic (characterized by assertiveness, beliefs of personal greatness, and feelings of superiority) and antagonistic (characterized by arrogance, quarrelsomeness, and exploitativeness) to neurotic (characterized by shyness, distrust, and shame; Back, 2018 ; Back et al., 2013 ; Crowe, Lynam, Campbell, & Miller, 2019 ; Grijalva & Zhang, 2016 ; Krizan & Herlache, 2018 ; Miller, Lynam, Hyatt, & Campbell, 2017 ). In this article, we focus on grandiose narcissism, a manifestation of narcissism characterized as a blend of agentic and antagonistic features ( Back et al., 2013 ; Crowe et al., 2019 ; Grijalva & Zhang, 2016 ; Krizan & Herlache, 2018 ; Miller et al., 2017 ). By contrast, we do not focus on vulnerable narcissism, which is a manifestation of narcissism characterized by a blend of neurotic and antagonistic features ( Krizan & Herlache, 2018 ; Miller et al., 2017 ). We also do not focus on narcissistic personality disorder, defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders as a “pervasive pattern of grandiosity (in fantasy or behavior), a constant need for admiration, and lack of empathy” ( American Psychiatric Association, 2013 , p. 669). This disorder can represent extreme levels of grandiose narcissism, vulnerable narcissism, or both ( Krizan & Herlache, 2018 ; Miller & Campbell, 2008 ; Miller et al., 2017 ). When we refer to narcissism or narcissists in this article, we respectively refer to grandiose narcissism or grandiose narcissists (i.e., individuals with relatively high levels of grandiose narcissism), unless otherwise specified.

Like others who have recently studied the narcissistic pursuit of status ( Zeigler-Hill, McCabe, Vrabel, Raby, & Cronin, 2018 ; Zeigler-Hill, Vrabel, et al., 2018 ), we argue that at the core of grandiose narcissism lies the hierarchical and comparative perspective that is characteristic of status hierarchies: Viewing oneself as superior implies viewing others as inferior; viewing oneself as entitled to special privileges implies viewing others as not. This hierarchical view of the self in relation to others is what also distinguishes narcissism from self-esteem. Whereas narcissism and self-esteem both entail positive self-views, narcissism and self-esteem differ in the quality of these self-views ( Brummelman, Thomaes, & Sedikides, 2016 ). Self-esteem captures self-views of adequacy and worth, not self-views of superiority ( Rosenberg, 1965 ). Unlike narcissism, self-esteem reflects a nonhierarchical way of viewing the self in relation to others ( Brummelman et al., 2016 ; Harris, Donnellan, & Trzesniewski, 2018 ). Narcissism and self-esteem are usually only weakly or modestly correlated ( Brummelman et al., 2016 ; Brummelman, Gürel, Thomaes, & Sedikides, 2018 ), with stronger relations for agentic features of narcissism and even negative relations for antagonistic features of narcissism ( Back et al., 2013 ; Geukes, Nestler, et al., 2017 ). Narcissism and self-esteem also have distinct nomological networks. Higher self-esteem is generally associated with lower levels of internalizing psychopathology and interpersonal aggression, whereas higher narcissism is generally not associated with symptoms of internalizing psychopathology but rather higher levels interpersonal aggression, as well as interpersonal problems ( Hyatt et al., 2018 ).

We argue that narcissists pursue status more strongly, more narrowly (i.e., at the cost of other fundamental motives), and more rigidly (i.e., even in contexts in which status pursuit is considered inappropriate) than nonnarcissists. Regarding the strength of the status motive, studies on implicit motivation ( Carroll, 1987 ; Joubert, 1998 ) have found that narcissists often construct projective narratives indicative of power motivation (i.e., the need to influence others; McClelland, 1987 ). Narcissists also attribute higher importance to acquiring leadership, fame, and wealth than nonnarcissists ( Abeyta, Routledge, & Sedikides, 2017 ). Both children and adults with narcissistic traits tend to set status-relevant goals, such as increasing in social rank, garnering respect, protecting their reputation, and influencing others ( Bradlee & Emmons, 1992 ; Jonason & Zeigler-Hill, 2018 ; Thomaes, Stegge, Bushman, Olthof, & Denissen, 2008 ; Zeigler-Hill, Vrabel, et al., 2018 ). This concern with acquiring status also permeates imaginary life: Narcissists have been found more likely than nonnarcissists to have fantasies and regular daydreams of heroism, glory, power, and success ( Raskin & Novacek, 1991 ). Because narcissists display a stronger motive for status than nonnarcissists, they may also pursue status more intensely than nonnarcissists do. For example, compared with nonnarcissists, narcissists have been shown to be more autocratic and assertive ( Raskin & Terry, 1988 ), to brag more ( Paulhus, Westlake, Calvez, & Harms, 2013 ), and to publicize their accomplishments more often ( McCain & Campbell, 2016 ).

Regarding the narrowness of the status motive, narcissists’ strong motive for status seems contrasted by a comparatively weak motive for affiliation. Indeed, studies on implicit motivation suggest a weak but negative association between narcissism and the construction of narratives indicative of affiliation and intimacy ( Carroll, 1987 ; Joubert, 1998 ). Likewise, narcissists are less likely than nonnarcissists to set goals related to affiliation, such as catering for the welfare of their social environments or forming close interpersonal bonds ( Bradlee & Emmons, 1992 ; Jonason & Zeigler-Hill, 2018 ; Thomaes, Stegge, et al., 2008 ; Zeigler-Hill, Vrabel, et al., 2018 ). The relative asymmetry between narcissists’ status and affiliation motives is also reflected in imaginary life, as narcissism is not associated with fantasies of love and closeness ( Raskin & Novacek, 1991 ). This narrow orientation on status might be backed up by narcissists’ relatively lesser motivation and capacity to show empathy for others ( Hepper, Hart, & Sedikides, 2014 ; Mota et al., 2019 ). Because narcissists’ motive for status can often trump their motive for affiliation, they may pursue status at the cost of their emotional bonds (akin to a behavioral profile of unmitigated agency; Bradlee & Emmons, 1992 ). For example, narcissists have been found more likely than nonnarcissists to see themselves as superior to others, even to their significant others ( Campbell, Rudich, & Sedikides, 2002 ; Krizan & Bushman, 2011 ), and more likely to be intimidating and aggressive ( Raskin & Terry, 1988 ).

Finally, regarding the rigidity of the status motive, research shows that narcissists have an increased tendency to orient behaviors toward pursuing desirable outcomes and a decreased tendency to inhibit behaviors that might lead to undesirable outcomes ( Foster & Trimm, 2008 ). As a result, narcissists tend to pursue status more rigidly than nonnarcissists do. For example, narcissists have been shown to be more likely to exaggerate their competences or lie to get ahead ( Lee & Ashton, 2005 ), even when they know that the truth can be unveiled ( Collins & Stukas, 2008 ). They are more likely to make high-risk investments ( Foster, Reidy, Misra, & Goff, 2011 ) and will less hesitantly attempt to maximize short-term profits at the cost of long-term losses ( Campbell, Bush, Brunell, & Shelton, 2005 ).

Together, these findings suggest that the narcissistic status motive is manifested in a behavioral profile of pervasive status pursuit. This observation builds on early theoretical accounts of narcissistic behavior. Early psychoanalytic writings profiled narcissists as agentic and antagonistic individuals: Regarding the former, they have been depicted as adept at leading, impressing, and demonstrating their superiority but, regarding the latter, they have been depicted as aggressive, confrontational, and arrogant ( Freud, 1931/1955 ; Reich, 1933/1949 ). More recent theoretical perspectives have similarly highlighted narcissists’ agentic and antagonistic interpersonal behaviors, which may result in the acquisition of a high status ( Back et al., 2013 ; Campbell & Campbell, 2009 ; Campbell & Foster, 2007 ; Krizan & Herlache, 2018 ; Sedikides & Campbell, 2017 ; Weiss, Campbell, Lynam, & Miller, 2019 ). To explain the motivational roots of narcissistic behaviors, theoretical perspectives have underlined narcissists’ craving for respect ( Baumeister & Vohs, 2001 ) or need for admiration ( Back et al., 2013 ; Morf & Rhodewalt, 2001 ) and thus indirectly hinted at a strong status motive. Tracing narcissists’ need for admiration to fundamental social motivations and similar to our approach, a recent theoretical account posited that narcissism is characterized by a strong status motive contrasted by a relatively weaker affiliation motive ( Zeigler-Hill, McCabe, et al., 2018 ). Building on this knowledge, we contend that a constellation of intrapersonal processes translates the narcissistic motive for status into status-pursuing behaviors. In the following section, we further outline a model that describes these processes and their temporal unfolding.

The SPIN Model

How does narcissists’ status motivation translate into status-pursuing behaviors? To address this matter, we present the SPIN model. The SPIN model zooms in on the moment-by-moment regulatory processes involved in narcissistic status pursuit. Regulatory processes are manifestations of motivation because they aim to reduce the negative discrepancy between people’s current state and their desired end state, such that these processes trigger one another in the service of optimal motive fulfillment ( Denissen, van Aken, Penke, & Wood, 2013 ). The output of each regulatory process can serve as the input of the next one ( Carver & Scheier, 1982 ; Denissen et al., 2013 ; Gross, 1998 ). From this process-oriented perspective, personality traits reflect the consistent and relatively stable ways in which people engage in regulatory processes ( Denissen et al., 2013 ; Winter, John, Stewart, Klohnen, & Duncan, 1998 ).

We posit that narcissism pertains to individual differences in a sequence of regulatory processes aimed at acquiring social status. In so doing, we build on core self-regulation processes (e.g., Baumeister, Schmeichel, & Vohs, 2007 ; Denissen et al., 2013 ; Geukes, van Zalk, & Back, 2018 ; Gross, 1998 ): situation selection, 1 attention (which we term vigilance for reasons outlined below), appraisal, and response execution. According to our model, narcissists tend to select social situations that appear to have the potential of affording a higher status. In these situations, narcissists are more likely to pay vigilant attention to cues that reveal their own and others’ status. These cues can indicate the extent to which narcissists’ status pursuit is facilitated or hindered. When assessing these cues, narcissists form appraisals about the relevant situational characteristics that determine how to obtain status: Can status be acquired through self-promotion (i.e., by increasing narcissists’ own status) or other-derogation (i.e., by decreasing others’ status)? These appraisals inform the respective behavioral responses aimed at status attainment. Because social hierarchies are dynamic and hence potentially susceptible to change, narcissists may be inclined to monitor their status and repeatedly resort to these status-pursuing processes. Through repetition and habit formation, the processes we describe might over time form a consistent, self-sustaining, and relatively stable system (i.e., a trait) that manifests itself within person–environment transactions ( Fig. 1 ).

Hypothesized self-regulation model of narcissistic status pursuit. Once narcissists select or otherwise encounter a status-relevant situation, they are more likely to attend to cues that indicate whether the environment facilitates or hinders status pursuit. Perceived facilitation of status pursuit might activate appraisals about the heightened utility of self-promoting behaviors in granting status, leading to the enactment of self-promoting behaviors (admiration pathway). By contrast, perceived hindrance of status pursuit might activate appraisals about the heightened utility of other-derogating behaviors in granting status, leading to the enactment of other-derogating behaviors (rivalry pathway). Self-promoting and other-derogating behaviors might in turn elicit status-relevant reactions from others, thus triggering the processes anew.

Like other models of narcissism (e.g., Back et al., 2013 ; Campbell, Brunell, & Finkel, 2006 ; Morf & Rhodewalt, 2001 ), the SPIN model conceptualizes narcissism as a dynamic system of regulatory processes. We extend these models in several ways. For the most part, existing models of narcissism have outlined its motivational nature ( Baumeister & Vohs, 2001 ; Zeigler-Hill, McCabe, et al., 2018 ), its factor structure ( Krizan & Herlache, 2018 ; Miller et al., 2017 ; Weiss et al., 2019 ), its self-regulatory strategies ( Campbell & Foster, 2007 ; Morf & Rhodewalt, 2001 ), or its social consequences ( Campbell & Campbell, 2009 ; Sedikides & Campbell, 2017 ) over time. Our model bridges these perspectives, showing how narcissism can be broken down into a sequence of self-regulation processes aimed at obtaining social status. Furthermore, our model builds on the Narcissistic Admiration and Rivalry Concept ( Back, 2018 ; Back et al., 2013 ), which describes the self-aggrandizing (narcissistic admiration ) and other-derogating (narcissistic rivalry ) manifestations of grandiose narcissism. As such, our model makes predictions about when and why narcissistic status pursuit takes on an assertive, self-aggrandizing flavor or an antagonistic, other-derogating one.

Existing models (e.g., Back et al., 2013 ; Morf & Rhodewalt, 2001 ) often posit that the main motivational driver of narcissism is the desire to create and maintain an overly positive, grandiose self-image (i.e., an intrapsychic motive), which may manifest itself in attempts to garner positive information about the self, including admiration. Extending this notion, we suggest that narcissists’ intrapsychic motive to establish a grandiose self-image serves a higher-order social motive—to obtain social status (for a review of intrapsychic vs. interpersonal motives, see Leary, Raimi, Jongman-Sereno, & Diebels, 2015 ). From an evolutionary perspective, humans have evolved mechanisms to navigate life in a way that maximizes their chances of survival and reproduction—outcomes that are often achieved in interaction with others ( Leary et al., 2015 ). Thus, intrapsychic means typically serve interpersonal ends. Indeed, evolutionary models and research findings suggest that a grandiose self-image helps people accrue social benefits by convincing others of their superior skills ( Anderson, Brion, Moore, & Kennedy, 2012 ; Dufner, Gebauer, Sedikides, & Denissen, 2018 ; Kennedy, Anderson, & Moore, 2013 ; Von Hippel & Trivers, 2011 ). In that sense, narcissists’ positive views of themselves may serve their overarching goal of obtaining social status.

An additional contribution of the SPIN model is that it specifies the moment-to-moment processes through which narcissists pursue status. As these processes are temporally linked, our model can be tested in field experiments aiming to investigate how narcissistic status pursuit might be modified. An implication of our model is that targeting earlier steps in the chain of self-regulation processes may be more effective in modifying status pursuit than targeting later ones. Finally, our model provides a unique window on the development of narcissism. Building on knowledge of when the motive for status becomes salient during development, our model outlines possibilities regarding when individual differences in narcissism can emerge, become socialized, and maintained over time. Before we describe these contributions in more detail, in the following section we review each of the processes that are outlined in our model.

Situation selection

Situation selection refers to approaching or avoiding social environments that help or hinder goal pursuit ( Gross, 1998 ). Such environments are selected on the basis of prior experiences in these or similar environments.

We argue that narcissists prefer, and thus tend to select, public and hierarchical social environments because these environments have a higher likelihood of affording status. Three strands of empirical evidence back up this claim.

First, narcissists tend to select public over private social settings because in such settings they can place themselves in the limelight of social activity and earn the status they pursue. For example, narcissists often select environments rich in social interactions, wherein opportunities for elevating their social image are abundant ( Bradlee & Emmons, 1992 ; Morf & Rhodewalt, 2001 ). Perhaps for this reason, narcissists on average prefer ( Jonason, Wee, Li, & Jackson, 2014 ; Kowalski, Vernon, & Schermer, 2017 ) and often pursue careers that enable them to be at the center of attention and rise through societal ranks. Consistent with these findings, narcissism levels are indeed elevated among actors ( Dufner et al., 2015 ) and celebrities ( Young & Pinsky, 2006 ).

Second, narcissists have been shown to choose hierarchical over egalitarian settings, provided they can gain status in these settings ( Alba, McIlwain, Wheeler, & Jones, 2014 ; Zitek & Jordan, 2016 ). As hierarchical settings promote competition and reward superior competences, they are the natural habitats in which status can be obtained. Consistent with this idea, narcissism levels are elevated in wealthy individuals ( Leckelt et al., 2019 ) and chief executive officers (CEOs; Rosenthal & Pittinsky, 2006 ).

A third strand of evidence concerns narcissists’ relationship choices. Because humans are a social species, relationship choices are an important feature of situation selection. Narcissists are more likely to choose relationships that elevate their status over relationships that cultivate affiliation. For example, narcissists are keener on gaining new partners than on establishing close relationships with existing ones ( Wurst et al., 2017 ). They often demonstrate an increased preference for high-status friends ( Jonason & Schmitt, 2012 ) and trophy partners ( Campbell, 1999 ), perhaps because they can bask in the reflected glory of these people.

In sum, narcissists are more likely to select social environments that allow them to display their performances publicly, ideally in competition with others. These settings are potentially more accepting and reinforcing of narcissistic status strivings.

Vigilance refers to a chronic state of biased attention toward specific classes of environmental cues, which are often related to goal pursuit. Individuals are assumed to be especially vigilant toward environmental cues that convey information about how much environments facilitate or hinder their goal pursuit ( Crick & Dodge, 1994 ). Vigilance can aid goal pursuit because it enables heightened processing of and responsiveness to goal-relevant cues ( Schultheiss, 2001 ). Because vigilance requires prior knowledge of the extent to which cues can be relevant to goal pursuit, it also encompasses the automatic encoding of cues’ relevance or irrelevance to goal pursuit ( Pratto & John, 1991 ).

Individuals who pursue status tend to be more vigilant toward observable cues of their own and others’ status ( Anderson et al., 2015 ). We assume that the same applies to narcissists, who tend to closely monitor the social image they convey and wish to be perceived as admirable figures ( Kowalski, Rogoza, Vernon, & Schermer, 2018 ; Zeigler-Hill, Vrabel, et al., 2018 ). To monitor how their pursuit of status is faring in their social environments, narcissists may vigilantly attend to cues that reflect how much status they earn through their behaviors. They might, for example, vigilantly observe the amount of attention (e.g., holding others’ visual attention) and admiration (e.g., receiving praise or eliciting expressions of awe) they earn, as well as the direct influence (e.g., others following their guidance) they exert compared with their competitors in the social hierarchy. After all, these cues can reveal the extent to which individuals gain, maintain, or lose the status they pursue ( Anderson & Kilduff, 2009b ; Cheng et al., 2013 ).

We also suggest that narcissists vigilantly attend to other people’s efforts at status pursuit because these efforts can hinder narcissists’ own status goals. For example, we expect that narcissists are more likely to deploy their attention to luxurious items others might possess, to external features such as physical attractiveness, or to others’ expressions of pride and social aloofness. These observable cues are more likely to capture narcissists’ attention because they are indicative of social status ( Mattan et al., 2017 ). Likewise, narcissists may be more vigilantly observant of others’ self-promoting or other-derogating behaviors, as these behaviors often reflect attempts to increase in status ( Anderson et al., 2015 ; Cheng et al., 2013 ) and can thus signal a hindrance to narcissists’ own status pursuit.

For the same reasons, narcissists may also be particularly sensitive to cues that convey hindrances to their own status pursuit. Such cues can range from those directly indicating a loss of status (i.e., being derogated by others) to subtler behavioral or lexical cues that reveal possible threats to status. Attesting to this, when primed with failure, narcissists tend to be faster than nonnarcissists in recognizing words associated with worthlessness—a finding suggestive of higher vigilance in encoding cues related to the loss of status ( Horvath & Morf, 2009 ).

In sum, narcissists are more likely to pay vigilant attention to external cues of their own and others’ social status. These cues can signal that a situation affords status and indicate the extent to which one’s social environment facilitates or hinders status pursuit.

Goal-relevant cues can set in motion individuals’ appraisal of the situation. We define appraisal as the assessment of situational affordances toward goal-fulfilling behaviors. Appraisals therefore direct the selection of goal-fulfilling behaviors ( Crick & Dodge, 1994 ; Lazarus, 1993 ) in response to cues indicating that a situation is relevant to goal fulfillment.

Evidence suggests that there are two fundamental pathways by which individuals can gain status. The first pathway concerns elevating one’s status by constructing a positive reputation of oneself. This is usually achieved through convincing audiences of one’s superior competence and worth (self-promotion, or prestige; Anderson & Kilduff, 2009a ; Back et al., 2013 ; Cheng & Tracy, 2014 ). The second pathway concerns decreasing competitors’ status by constructing a negative reputation of competitors. This is usually achieved through convincing audiences of competitors’ inferior competence and worth (other-derogation, or dominance; Back et al., 2013 ; Cheng & Tracy, 2014 ). Narcissism is associated with the use of both behavioral strategies for status attainment ( Zeigler-Hill, Vrabel, et al., 2018 ). We posit that, once narcissists find themselves in a situation that affords status (i.e., when their attention grasps status-relevant cues), they assess whether self-promotion or other-derogation is most likely to succeed in securing status. Situational cues indicating facilitation of status pursuit can trigger appraisals about the heightened utility of self-promotion, whereas situational cues indicating hindrance of status pursuit can trigger appraisals about the heightened utility of other-derogation.

We argue that, by default, narcissists tend to appraise situations as facilitating status pursuit and hence appraise them as affording self-promotion ( Back, 2018 ; Wetzel, Leckelt, Gerlach, & Back, 2016 ). We attribute this tendency to narcissists’ unrealistically positive, inflated self-views in status-relevant domains. For example, narcissists often believe that they are incredibly attractive ( Gabriel, Critelli, & Ee, 1994 ), even when others might think that they are not. Furthermore, narcissists often believe that they possess superior intellect, even when their actual IQ scores are not on par ( Campbell et al., 2002 ; Dufner, Denissen, et al., 2013 ). Likewise, narcissists may think that they are exceptionally good at understanding others’ intentions and emotions despite often being less capable of doing so ( Ames & Kammrath, 2004 ; Mota et al., 2019 ). In addition, narcissists may think that they are highly creative, even when objective assessments might dispute it ( Goncalo, Flynn, & Kim, 2010 ). Finally, narcissists often see themselves as charismatic leaders, even when they might disrupt group performance ( Judge, LePine, & Rich, 2006 ; Nevicka, Ten Velden, De Hoogh, & Van Vianen, 2011 ). As a result of these broad, inflated self-perceptions, narcissists may be more inclined to appraise situations as affording self-promotion rather than other-derogation.

If narcissists are so strongly inclined to appraise that environments afford self-promotion, when might they attempt to derogate others? We argue that narcissists will be inclined to derogate others when they appraise that situational status demands exceed their resources for self-promotion. For example, when confronted by a formidable status competitor, narcissists might be more inclined to exert effort into defaming the competitor because doing so can potentially damage that person’s reputation and thus decrease that person’s status. The gravitation toward other-derogation is especially salient in situations in which cues signal a strong hindrance of narcissists’ own status pursuit. A large body of research suggests that when narcissists are criticized, humiliated, or outperformed by others, they seek to derogate them ( Bushman & Baumeister, 1998 ; Horton & Sedikides, 2009 ; Kernis & Sun, 1994 ; Stucke & Sporer, 2002 ; Thomaes, Bushman, Stegge, & Olthof, 2008 ). In such instances, a strategy for reclaiming at least some status can therefore be to derogate or be aggressive toward the evaluator, with the purpose of punishing him or her or defaming him or her in the eyes of others.

It should be underscored that other-derogation is often viewed as less socially desirable because it is a strategy that establishes status through conflict ( Cheng & Tracy, 2014 ). Narcissists, however, might be more inclined than nonnarcissists to view it as an acceptable avenue toward status attainment ( Carlson & Lawless DesJardins, 2015 ) for a number of reasons. First, because narcissists tend to value status over affiliation, they might be less averse to the possibility of becoming disliked as long as other-derogation can grant them the status they pursue.

Second, because of their heightened sense of entitlement (i.e., their sense of inherent deservedness), narcissists might form exaggerated expectations of status acquisition ( Grubbs & Exline, 2016 ). These expectations might eventually lead narcissists to underestimate the effort required to prove that they deserve to gain status. Research suggests that this might be the case, as entitled self-views are associated with an overestimation of the competence—and underestimation of the combativeness—that individuals display when pursuing status ( Lange, Redford, & Crusius, 2018 ; Scopelliti, Loewenstein, & Vosgerau, 2015 ). As a result of their heightened sense of entitlement, narcissists might be inclined to view the hindrances to self-promotion as unjust, which could lead them to retaliate when they are not granted their desired status.

Third, narcissists’ beliefs regarding their own superiority tend to go hand in hand with beliefs of others’ inferiority ( Back et al., 2013 ; Campbell et al., 2002 ; Kong, 2015 ; Krizan & Bushman, 2011 ; Park, Ferrero, Colvin, & Carney, 2013 ). These beliefs about others’ inferiority might be triggered by narcissists’ perceived hindrances to their own self-promotional efforts. Indeed, whereas narcissists have been found to attribute successes to internal ability more so than nonnarcissists, they have also been found to attribute their failures to the incompetence of their evaluators ( Horton & Sedikides, 2009 ) or collaborators ( Campbell, Reeder, Sedikides, & Elliot, 2000 ; Kernis & Sun, 1994 ). For the above reasons, narcissists might view their own derogating behaviors as justified attempts to claim or reclaim their rightful place in the social hierarchy and engage in such behaviors when situational cues indicate that self-promotion is unlikely to grant status.

In sum, after determining that a situation affords status, narcissists can appraise whether the situation calls for self-promotion or other-derogation as a means of status acquisition. Because of their beliefs in their own inherent superiority, narcissists typically prefer self-promotion over other-derogation. However, when narcissists are unlikely to meet the status demands by self-promoting, they may derogate others (e.g., belittle them, lashing out against them). Narcissists may view other-derogation as permissible and sometimes necessary because they tend to downplay its social consequences and often view hindrances to their self-promotion as unjust.

Response execution

Response execution refers to enacting behaviors that facilitate goal pursuit within a given situation. Responses are thus the behavioral outcomes of appraisals. We propose that narcissists are more likely to appraise situations as affording self-promotion and consequently more likely to behave in a more self-promotional, assertive attitude that aims to earn admiration, attention, and social influence ( admiration pathway). However, when narcissists believe that self-promotion is less likely to grant status, they might follow a combative behavior that aims to devalue social competitors ( rivalry pathway; Back, 2018 ; Back et al., 2013 ).

Admiration pathway

We propose that when narcissists appraise self-promotion to be a feasible route to status attainment, they use behaviors aimed at standing out. For example, narcissists might groom their appearance; they tend to prefer stylish clothing, luxurious brands, and belongings that they can publicly display to signal their high status ( Back et al., 2010 ; Cisek et al., 2014 ). Narcissists might also try to stand out through their communication style, which often involves charming facial expressions, humor, as well as expressive and confident gestures that reflect their extraversion and self-confidence ( Back et al., 2010 ; Paulhus, 1998 ; Tracy, Cheng, Martens, & Robins, 2011 ; Zeigler-Hill, Vrabel, et al., 2018 ). To draw attention to their superiority, narcissists often brag ( Buss & Chiodo, 1991 ) and exaggerate their positive attributes ( Collins & Stukas, 2008 ). Offline, narcissists might try to stand out by dominating social interactions, for example by interrupting or stirring the direction of conversations toward their accomplishments ( Vangelisti, Knapp, & Daly, 1990 ). Online, narcissists might similarly try to stand out by dominating social-media newsfeeds with frequent posts of their exercise habits, diets, and personal achievements ( Marshall, Lefringhausen, & Ferenczi, 2015 ; McCain & Campbell, 2016 ). Finally, narcissists might try to stand out through their acts. They might try to demonstrate their superior competences, for example, by showing off in the presence of potentially admiring bystanders ( Buss & Chiodo, 1991 ), by striving to publicly succeed in challenging tasks ( Wallace & Baumeister, 2002 ), or by publicly enacting altruistic behaviors, provided these behaviors increase status ( Konrath, Ho, & Zarins, 2016 ; Konrath & Tian, 2018 ). While engaging in these self-promoting behaviors, narcissists may visibly experience a sense of pride, which outsiders may view as arrogance ( Tracy, Cheng, Robins, & Trzesniewski, 2009 ).

When self-promoting, narcissists may sometimes trade off their pursuit of affiliation and the welfare of others. In one study, narcissists used a greater proportion of shared environmental resources in their attempt to supersede others in performance, ignoring the fact that their behavior would result in environmental costs and in a long-term depletion of the resources required to maintain their status ( Campbell et al., 2005 ). Furthermore, narcissists have been found to more lightheartedly excuse their immoral acts ( Egan, Hughes, & Palmer, 2015 ) and to ignore conventional behavioral rules such as following their boss’s instructions in the workplace ( Judge et al., 2006 ). In political positions, narcissists’ tendency for risk taking may sometimes drive them to initiate bold legislative changes with relative disregard for the negative consequences these changes can bring about, as documented by research on narcissistic U.S. presidents’ political acts ( Watts et al., 2013 ). Such findings indicate that narcissists are more likely to go all in on their self-promotional efforts to acquire status.

Rivalry pathway

We suggest that when narcissists determine that self-promotion cannot grant status, they are more likely to attempt to establish status by lowering the status of competitors. Because they tend to value status over affiliation, narcissists may quickly resort to aggression when they feel bossed around, insulted, or humiliated, perhaps in an attempt to regain their social status. Narcissists can resort to ethically questionable and coercive behaviors to acquire status ( Carlson & Lawless DesJardins, 2015 ; Zeigler-Hill, Vrabel, et al., 2018 ). Not only might they sometimes lie ( Lee & Ashton, 2005 ), insult ( Holtzman et al., 2010 ), and bully ( Reijntjes et al., 2016 ), but they can also retaliate with physical aggression toward those that obstructed their status pursuit (for a review, see Denissen, Thomaes, & Bushman, 2018 ). For example, in a series of experiments, narcissists were more aggressive than nonnarcissists toward those who criticized or outperformed them ( Bushman & Baumeister, 1998 ; Thomaes, Bushman, et al., 2008 ). Narcissistic aggression can also translate into direct physical violence outside the lab. A large body of evidence suggests that individuals who do not meet the status expectations they feel entitled to are more likely to engage in aggressive behavior ( Baumeister, Smart, & Boden, 1996 ; Denissen et al., 2018 ; Krizan & Johar, 2015 ; Rasmussen, 2016 ). For example, intimate partner violence is more likely when actors fail to meet narcissistic status demands (e.g., male perpetrators who earn less than their wife; Hornung, McCullough, & Sugimoto, 1981 ). Additional evidence shows that violent offenders display higher levels of narcissism than nonviolent offenders ( Bushman & Baumeister, 2002 ) and that narcissistic prison inmates are, on average, more violent than nonnarcissistic ones ( Lambe, Hamilton-Giachritsis, Garner, & Walker, 2018 ). Taken together, these findings indicate that narcissism can act as a catalyst of interpersonal conflict in the process of status pursuit.

While engaging in other-derogating behaviors, narcissists may be fueled by a sense of shame and anger. Indeed, frustration of status motivation tends to elicit shame ( Shariff, Tracy, & Markusoff, 2012 ) and anger ( Berkowitz, 1989 ). When narcissists are rejected by popular others, fail in the eyes of others, or do not receive the praise they expect, they might feel embarrassed or ashamed ( Brummelman, Nikolić, & Bögels, 2018 ). In response, narcissists might turn the feeling of shame into anger ( Thomaes, Stegge, Olthof, Bushman, & Nezlek, 2011 ), a phenomenon described as “humiliated fury” ( Lewis, 1971 ) or “narcissistic rage” ( Kohut, 1971 ).

When environments afford self-promotion, narcissists may engage in it to increase their status (admiration pathway). When self-promotion cannot grant status, narcissists may resort to antagonistic behaviors (rivalry pathway) to secure the status they feel entitled to.

Social consequences of admiration and rivalry

Because status pursuit is embedded in social transactions, narcissists’ status pursuit can shape the way others relate and behave toward them. Adopting a person–environment-fit perspective, we suggest that the consequences of narcissistic behaviors are largely dependent on whether social environments are oriented primarily toward status (e.g., job settings) or affiliation (e.g., friendship settings). In status-oriented settings, narcissistic status pursuit might be especially advantageous for a continuous rise in status. In affiliation-oriented settings, however, narcissistic status pursuit might allow individuals to rise in status initially but can also lead them to lose status over time (see also Back, Küfner, & Leckelt, 2018 ).

Status-oriented settings

In status-oriented settings, individuals are often expected to strongly pursue status but less so to pursue strong interpersonal bonds. Because in such settings the formation of strong affiliative bonds is often secondary and interpersonal relationships are often more shallow, narcissistic admiration can allow individuals to rise in status without necessarily becoming disliked. In fact, narcissists are likely to acquire a high status and become well-liked in short-term acquaintances and self-presentational settings because in such settings affiliative bonds are more shallow and less intimate ( Back et al., 2010 ; Carlson & Lawless DesJardins, 2015 ; Dufner, Rauthmann, Czarna, & Denissen, 2013 ; Lamkin, Clifton, Campbell, & Miller, 2014 ; Leckelt, Küfner, Nestler, & Back, 2015 ; Oltmanns, Friedman, Fiedler, & Turkheimer, 2004 ; Paulhus, 1998 ). Narcissists may become liked in such settings in part because their narcissistic traits are often misperceived as self-esteem, which is generally desirable regardless of social setting ( Giacomin & Jordan, 2018 ). This quick boost in likability and status that is associated with narcissistic admiration can be especially beneficial for navigating hierarchies. Because of their self-promotion, narcissists tend to be more preferred than nonnarcissists when applying for a job ( Paulhus et al., 2013 ), and they have a relatively high probability of acquiring leadership positions ( Brunell et al., 2008 ; Nevicka, De Hoogh, Van Vianen, Beersma, & McIlwain, 2011 ), even when they have less experience than their nonnarcissistic competitors ( Nevicka, Van Vianen, De Hoogh, & Voorn, 2018 ).

Narcissistic admiration can thus facilitate a rise in social status with minimal (if any) social costs and may render narcissists more likely to occupy pivotal positions in society in the long term. Narcissism levels are higher among successful artists ( Zhou, 2017 ), wealthier individuals ( Leckelt et al., 2019 ), CEOs in general ( Chatterjee & Hambrick, 2007 ), and high-paid CEOs in particular ( O’Reilly, Doerr, Caldwell, & Chatman, 2014 ), and U.S. presidents ( Watts et al., 2013 ). Thus, narcissistic admiration may be advantageous in the environments revolving around status (e.g., personal distinction, public recognition). In these environments, the admiration pathway can eventually make narcissists stand out in the eyes of others and render them more likely to get ahead of nonnarcissistic social competitors.

Like the admiration pathway, the rivalry pathway can be advantageous for individuals in status-oriented settings. Given that narcissistic rivalry is often viewed as less socially desirable, we propose that it might be useful in obtaining status when groups are faced with internal or external threats that endanger the group’s hierarchy or survival. It is possible that the combativeness associated with rivalry is viewed as an asset of leaders in such cases: Rivalrous leaders might convey the impression that they will fight to protect the group from external threats and impose their will to maintain in-group order. Indeed, especially in times of economic or personal uncertainty, groups have been shown to elect more dominant ( Kakkar & Sivanathan, 2017 ) and narcissistic ( Nevicka, De Hoogh, Van Vianen, & Ten Velden, 2013 ) leaders. Furthermore, groups have been found to elect more dominant individuals as negotiators in zero-sum, intergroup debates ( Halevy, Chou, Cohen, & Livingston, 2012 ). These findings suggest that in times of threat, narcissistic rivalry might be a less aversive or even a more desirable feature of the people elected as leaders. In such cases, narcissists may thus be at a relative advantage of ascending the hierarchy and maintaining a high status.

Affiliation-oriented settings

In affiliation-oriented settings, such as friendships, individuals are often expected to pursue the formation of interpersonal bonds but less so to pursue status. Consequently, in these settings, the strong and continuous pursuit of status might be met with increasing dislike. Although narcissistic admiration might allow individuals to increase in status and become more liked in early stages of interpersonal transactions in affiliative settings, it might be less effective in maintaining status and likability over time. Narcissists’ rigid self-promotion is assumed to exhaust social interaction partners over time ( Campbell & Campbell, 2009 ; Sedikides & Campbell, 2017 ). Indeed, narcissists may become disliked for their bragging ( Scopelliti et al., 2015 ). Consequently, interaction partners may withdraw their admiration or respond to narcissists’ demands for admiration with conflict. Narcissists might perceive such behaviors as hindrances to status pursuit, which may increase their rivalrous behaviors, thus often escalating such interpersonal conflict. The gradual emergence of rivalry in affiliative settings can eventually damage narcissists’ relationships with others ( Campbell & Campbell, 2009 ; Sedikides & Campbell, 2017 ). Studies focusing on the formation of affiliative bonds among previously unacquainted individuals found that, at early stages of acquaintance, narcissists were more likely to increase in status and likability. However, as interactions grew more intimate, narcissists were more likely to lose their initially high status and to become less trusted and liked over time, especially because of their antagonistic behaviors ( Carlson & Lawless DesJardins, 2015 ; Küfner, Nestler, & Back, 2013 ; Leckelt et al., 2015 ; Paulhus, 1998 ). Therefore, narcissistic status strivings in affiliative settings might be less successful in garnering a long-term advantage in social status, while often damaging interpersonal bonds.

Our model is consistent with the possibility that narcissistic admiration and rivalry can be advantageous for status pursuit in hierarchical settings. By contrast, narcissistic admiration, and especially narcissistic rivalry, seems less advantageous in affiliative settings. In such settings, the continuous pursuit of status and the gradual emergence of rivalrous behaviors may be responsible for narcissists’ relative decrease in status and likability over time.

Theoretical Implications

According to the model we have introduced, narcissism is expressed as individual differences in a sequence of momentary processes aimed at the attainment of social status. Because of the dynamic nature of social hierarchies, the motive for status can be satisfied only briefly. Consequently, corresponding motivations tend to reemerge throughout daily life, resulting in status-pursuing behaviors that become increasingly consistent and stable over time. As we argue below, our theoretical perspective can be used to identify processes (such as those pertaining to status pursuit) underlying personality traits. Moreover, it sheds light on how narcissism manifests itself across contexts, how it can develop across the life span and between contexts, as well as how its underlying processes can possibly be targeted experimentally.

Individual differences in status pursuit

Humans do not pursue status in uniform ways. Evolutionary models of personality underscore that individual differences in personality traits can reflect individual differences in the strategies toward the attainment of social goals, such as status (e.g., Cheng & Tracy, 2014 ). Narcissism might have evolved as a psychological mechanism that facilitates the pursuit of status ( Mahadevan, Gregg, Sedikides, & de Waal-Andrews, 2016 ) because findings show that it is consistently associated with the successful navigation of hierarchies.

Our model can provide insight into why narcissism might differ from seemingly similar traits that are also associated with the pursuit of status. Some scholars have proposed that narcissism belongs to a broader group of so-called dark traits (including Machiavellianism and psychopathy; Paulhus & Williams, 2002 ) that represent a tendency to “maximize one’s own utility” while “disregarding, accepting, or malevolently provoking disutility for others” ( Moshagen, Hilbig, & Zettler, 2018 , p. 657). Although these personality traits are all linked to a relatively strong status motive, narcissism stands out as the trait most strongly associated with status motivation ( Jonason & Ferrell, 2016 ; Jonason & Zeigler-Hill, 2018 ; Moshagen et al., 2018 ). That is, although individuals with psychopathy or Machiavellianism may pursue social status through the same self-regulatory processes as narcissists do, they probably do so with less intensity, pervasiveness, and rigidity. If this is the case, then they may pursue social status in more context-sensitive ways (e.g., only in settings in which social status can benefit or at least does not hinder their pursuit of other important motives). For example, Machiavellians are also oriented toward status, but they are thought to mainly pursue control over others ( Lee & Ashton, 2005 ). Machiavellians might thus engage in similar status-pursuing processes that narcissists do, but perhaps only in situations in which status can enable them to acquire such control (e.g., in their jobs but not in their intimate relationships). In that sense, antagonistic personality traits may, in part, reflect individual differences in the strength or dominance of the status motive.

A within-person perspective on narcissistic admiration and rivalry

A long-standing challenge in personality research has been to integrate process models of personality (i.e., within-person models) that predict why the same individual behaves differently from context to context with structural models of personality (i.e., between-person models) that predict why individuals tend to behave differently from one another ( Baumert et al., 2017 ). Some researchers (e.g., Geukes et al., 2018 ; Hopwood, 2018 ; Wrzus & Roberts, 2017 ) have recently proposed broad, generic models of personality that address this matter, decomposing trait concepts into momentary state processes, the recurrence of which can lead to relatively predictable and recurring outcomes that are perceived as stable, dispositional trait differences. We hope that our framework can contribute to this growing body of literature by providing concrete examples of how such processes might operate in the case of narcissism. Our framework assumes that individual differences in narcissism can be conceptualized as individual differences in a sequence of state-like processes that emerge in interactions with the environment when individuals pursue status. Viewing narcissism as a recurring sequence of motivated processes can enhance our understanding of why it tends to present itself differently across contexts, why it tends to present itself in similar ways within similar contexts, and how it potentially develops over time ( Denissen et al., 2013 ). Thus, starting from a sequence of within-person processes of status pursuit, the SPIN model outlines process outcomes whose recurrence can lead to the stabilization and development of between-person differences in narcissism.

This within-person perspective is especially relevant in understanding the distinct manifestations of narcissism. Recent years have witnessed an upsurge in empirical and conceptual attempts to pin down the manifestations, structure, and nomological network of grandiose narcissism. This upsurge has culminated in the distinction between two interrelated trait dimensions: (a) narcissistic grandiosity (or admiration), which is correlated with agentic extraversion and sensitivity to positive rewards (i.e., high approach motivation) and can be manifested in self-promoting behaviors of status pursuit; and (b) entitlement (or rivalry), which is correlated with antagonism (i.e., low agreeableness) and can be manifested in other-derogating behaviors of status pursuit ( Back et al., 2013 ; Crowe et al., 2019 ; Krizan & Herlache, 2018 ; Lange et al., 2018 ; Miller et al., 2017 ; Weiss et al., 2019 ; Zeigler-Hill, Vrabel, et al., 2018 ). Moving beyond this descriptive level, our model attempts to explain why these outwardly distinctive dimensions nevertheless represent the same construct, in what processes they differ, and how they might develop.

Extending existing theory, our model provides a motivational explanation of why admiration and rivalry represent the same construct (i.e., why they are both manifestations of narcissism). Scholars have suggested that admiration and rivalry share a common motive (i.e., the motive to become grandiose; Back et al., 2013 ). Extending this proposition, we suggest that the common motive underlying admiration and rivalry is the motive for social status. Preliminary evidence supports the idea that status motivation underlies both admiration and rivalry, as it shows that admiration and rivalry are more strongly associated with the status motive than with other social motives, such as the affiliation motive ( Zeigler-Hill, Vrabel, et al., 2018 ).

Furthermore, our model illustrates why and how admiration and rivalry are distinct manifestations of narcissism. Our model holds that narcissists, after determining that a situation affords status, are more likely to appraise whether the situation calls for self-promotion or other-derogation as a means of status acquisition. Some situations might be perceived as facilitating the pursuit of status, possibly activating appraisals about the heightened utility of self-promotion and triggering self-promoting behaviors (admiration pathway). Other situations might be perceived as hindering the pursuit of status, possibly activating appraisals about the heightened utility of other-derogation and triggering other-derogating behaviors (rivalry pathway). Thus, moving beyond prior work on between-person differences in admiration and rivalry, our model illustrates why admiration and rivalry might reflect two distinct process outcome chains that fluctuate within individuals, depending on their appraisals of the social contexts.

Moreover, our model illustrates how individual differences in admiration and rivalry might develop through interpersonal transactions. Over time, the frequency with which individuals pursue status through admiration or rivalry may crystallize into more stable, trait-like patterns that represent between-person differences in admiration and rivalry ( Back, 2018 ). If individuals primarily feel they can keep on earning status through self-promotion, they might be more inclined to behave in an increasingly self-aggrandizing manner (i.e., they might develop higher levels of admiration over time). Evidence in support of this hypothesis shows that narcissistic self-views are momentarily increased when individuals rise in status ( Mahadevan, Gregg, & Sedikides, 2018 ). Likewise, if individuals primarily feel that their status pursuit is hindered and the main avenue to status is through derogating others, they might be more inclined to behave in an increasingly other-derogating manner (i.e., they might develop higher levels of rivalry over time). Confirming the basis of these assumptions, daily perceptions of status gain have been related to admiration, whereas daily perceptions of status loss have been related to rivalry ( Zeigler-Hill, Vrabel, et al., 2018 ). Our model hence offers an integrative perspective into how intraindividual differences in status pursuit can stabilize and intensify interindividual differences in admiration and rivalry.

We propose that admiration represents the “default mode” of narcissists, such that narcissists display rivalry mainly when their self-promoting efforts have been frustrated. This suggests that antagonistic strivings (which we label rivalry) are essential in understanding the spectrum of narcissistic behaviors but that their emergence might be more situational, such that they characterize some narcissists more so than others. Indeed, although dark personality traits (e.g., Machiavellianism, psychopathy, and narcissism) share a common feature of antagonism, this feature seems to explain a relatively low proportion of variance in narcissism ( Moshagen et al., 2018 ). Moreover, latent class analyses identified two subgroups of narcissists: those characterized by moderate levels of admiration and low levels of rivalry and those characterized by moderate to high levels of both admiration and rivalry. They did not, however, identify subgroups of narcissists characterized by moderate or high levels of rivalry and low levels of admiration ( Wetzel et al., 2016 ). These findings tentatively suggest that, without exhibiting high levels of admiration, people are unlikely to exhibit high levels of rivalry. Drawing from these findings, we suggest that narcissistic admiration is the most salient manifestation of narcissism, with rivalry primarily emerging when admiration is not sufficient to establish status.

Development of narcissism across the life span

Our model proposes that the strength of people’s status motive underlies their narcissism levels. Some models of personality development suggest that developmental patterns of personality traits are guided by changes in motivation (e.g., Denissen et al., 2013 ). Thus, as the importance of status waxes and wanes across the life span, so might narcissism.

Current findings provide preliminary support for this hypothesis. Already from a preschool age, children start to reflect on their competences ( Dweck, 2017 ) and compete with others for tangible resources (e.g., toys; Hawley, 1999 ). At this age, attention seeking and interpersonal antagonism have been found to be precursors of later narcissism ( Carlson & Gjerde, 2009 ). Narcissism first emerges as relatively stable individual differences in self-views around the age of 7 years ( Thomaes & Brummelman, 2016 ), a time when self-promotion gains ground as the primary route toward status attainment ( Hawley, 1999 ), and children start to reflect on their social status through more realistic social comparisons ( Ruble & Frey, 1991 ). Moving on to adolescence, mean levels of narcissism increase ( Klimstra, Jeronimus, Sijtsema, & Denissen, 2018 ). This increase might be facilitated by physical changes such as rising testosterone levels ( Braams, van Duijvenvoorde, Peper, & Crone, 2015 ), which might strengthen the motive for status during adolescence (see Terburg & van Honk, 2013 ; Yeager, Dahl, & Dweck, 2018 ). Social status indeed becomes highly important during this period ( LaFontana & Cillessen, 2010 ) and is salient in adolescents’ fantasies: Adolescents seem preoccupied with their social image and appear to believe that others are constantly evaluating them ( Elkind, 1967 ). Given the high competition for status in adolescence, adolescents may be susceptible to resort to both self-promotion and other-derogation in their efforts to establish their status in the peer group ( Olthof, Goossens, Vermande, Aleva, & van der Meulen, 2011 ).

Mean levels of narcissism continue to increase ( Klimstra et al., 2018 )—or at least do not decrease ( Grosz et al., 2017 )—during young adulthood, because narcissism might have an adaptive function at this age. Narcissism might be beneficial not only for young adults’ amassment of sexual experiences (because narcissists are perceived as attractive; Dufner, Rauthmann, et al., 2013 ) but also for job acquisition. As unemployment rates in young adulthood are much higher than for other age groups (e.g., Eurostat, 2018 ), the competition for jobs may be fierce at this age. To land a job, young adults are often required to convince a potential employer—usually during a brief, self-presentational interview—that they are confident, ambitious, and talented. This sort of self-promotion often makes narcissists, who tend to thrive in self-presentational settings, the most appealing job candidates ( Paulhus et al., 2013 ).

Cross-sectional evidence suggests that from young adulthood onward, narcissism tends to decline gradually ( Foster, Campbell, & Twenge, 2003 ; Klimstra et al., 2018 ; Trzesniewski, Donnellan, & Robins, 2008 ). After young adulthood, individuals might have acquired a more consolidated status in their social environments (e.g., they usually have finished their academic development and have found employment), whereas goals pertaining to affiliation and intimacy (e.g., finding a long-term partner, procreating, spending more time with loved ones) might become more salient ( Carstensen, Isaacowitz, & Charles, 1999 ; Erikson, 1959 ). Such a motivational shift from status to affiliation goals may also explain why narcissism tends to be on average less and less desirable as adults grow older ( Berenson, Ellison, & Clasing, 2017 ).

Consistent with our model, these findings suggest that mean-level changes in narcissism across the life span may reflect developmental changes in the motivation to obtain social status. Narcissism seems to rise when status goals become more important but to fall when status goals become less important. Future research could examine this possibility directly, for example by examining whether mean-level changes in narcissism are mediated by mean-level changes in the salience of status goals across the life span.

Development of individual differences in narcissism

Because we argue that status motivation underlies the development of narcissism, our theoretical framework can also contribute to the understanding of how individual differences in narcissism might develop through the reinforcement of status pursuit across social environments. Narcissism is partly heritable (for a review, see Luo & Cai, 2018 ). At the same time, the development of narcissism is also thought to be shaped by socialization experiences ( Kernberg, 1975 ; Kohut, 1971 ; Millon, 1969 ). Parents may reinforce narcissism by reinforcing the pursuit of status, and initial evidence supports this assumption. Narcissism seems to be cultivated, in part, by parental overvaluation, which is defined as parents seeing their child as more special and more entitled than others ( Brummelman, Thomaes, Nelemans, Orobio de Castro, Overbeek, & Bushman, 2015 ). Overvaluing parents on average overestimate children’s IQ scores, overclaim children’s knowledge, and overpraise children’s mathematics performances, while pressuring their child to stand out from others (e.g., by giving them a unique, uncommon first name; Brummelman, Thomaes, Nelemans, Orobio de Castro, & Bushman, 2015 ). Thus, overvaluing parents seem concerned with their children’s social status. Parental overvaluation predicts narcissism in children over time, even when parents’ own narcissism, which is associated with parental overvaluation, is taken into account. This finding suggests that overvaluation might indeed influence the development of narcissism above and beyond genetic transmission ( Brummelman, Thomaes, Nelemans, Orobio de Castro, Overbeek, & Bushman, 2015 ). Genetically informed studies should corroborate this.

Consistent with our model’s suggestion that status goals can direct the development of narcissism, some theories suggest that narcissism represents a sense of self defined primarily by external validation ( Kohut, 1971 ; Winnicott, 1960 ). It is possible that parents of narcissistic children explicitly encourage them to value and pursue status, for example by pushing their children to stand out from others, by emphasizing the status-enhancing nature of their children’s accomplishments, or by making their approval of children conditional on the children’s attainment of a high status. When children gain status, parents may lavish them with praise ( Brummelman, Nelemans, Thomaes, & Orobio de Castro, 2017 ), but when children lose status, parents may become cold ( Otway & Vignoles, 2006 ) or even hostile toward them ( Wetzel & Robins, 2016 ). Indeed, the experience that parents’ regard is conditional might be an important factor in the early development of narcissism ( Assor & Tal, 2012 ; Brummelman, 2018 ), and future studies could explore this possibility directly by zeroing in on parent–child transactions.

Research on the development of individual differences in narcissism is still in its infancy. By proposing that the reinforcement of status motivation in the family might contribute to narcissism, our model creates an overarching framework that abridges theoretical suggestions and findings from socialization research on narcissism. In addition, our model generates novel hypotheses for future research, such as that narcissism may be reinforced across the life span by settings that reinforce status pursuit, even outside of the family. Narcissists might compete for status in their peer groups ( Poorthuis, Slagt, van Aken, Denissen, & Thomaes, 2019 ), sports teams ( Roberts, Woodman, & Sedikides, 2018 ), and occupational settings ( Grijalva, Harms, Newman, Gaddis, & Fraley, 2015 ). As they move to increasingly high-status positions, their narcissism levels may further rise ( Mahadevan et al., 2018 ). Combined with genetically informed studies, studies that address the lifelong socialization of status motivation might advance our knowledge of why and how some individuals might become more narcissistic than others.

Future Directions: Toward a Systematic Validation of the Model

The central premise of the SPIN model is that narcissism becomes manifested as individual differences in how people pursue status. These differences manifest themselves in core self-regulation processes: situation selection, vigilance, appraisal, and response execution, driven by an underlying status motive. Not all of these processes have received the same amount of empirically scrutiny in relation to narcissism, however. There is considerable evidence for the associations between narcissism and status motivation, situation selection, and response execution (e.g., self-promoting and other-derogating behaviors). By contrast, despite theoretical propositions (e.g., Cisek et al., 2014 ) and indirect evidence (e.g., Horvath & Morf, 2009 ) vigilance has not been studied in relation to narcissism. Likewise, despite theoretical propositions (e.g., Coleman, Pincus, & Smyth, 2019 ) and indirect evidence (e.g., Birkás, Gács, & Csathó, 2016 ), appraisals have not been studied in relation to narcissism. Future research should examine these proposed processes in narcissistic status pursuit. Although it will be important to isolate these processes in laboratory experiments, perhaps the most exciting prospect will be to examine how all proposed processes unfold over time in people’s lives. We propose both longitudinal and experimental tests of these processes.

Longitudinal tests of the model

Given that the SPIN model focuses on the moment-by-moment processes through which narcissists pursue status, we believe intensive longitudinal designs are well suited to test it. In such designs, researchers should assess the self-regulatory processes that our model proposes in real life, as they unfold in narcissists’ actual social interactions. This would allow researchers to test core assumptions of the model simultaneously.

One core assumption of our model is that narcissism is reflected in distinct self-regulation processes of status pursuit. According to the model, these processes can explain when individuals might engage in admiration and when individuals might engage in rivalry in their daily status pursuits. A challenge for the field will be to develop precise and sensitive measures for the self-regulation processes that underlie narcissistic status pursuit. To address this issue, future studies could use multiple sources of information in conjunction with self-reports to measure each process in the moment. Experience-sampling designs allow researchers to track these moment-by-moment processes in real time. Smartphones have allowed researchers to directly notify participants to fill out self-reports of their momentary experiences ( Harari et al., 2016 ; Wrzus & Mehl, 2015 ), which may be particularly useful in tracking individuals’ vigilance and appraisals of their social contexts. To examine vigilance, researchers could measure how much individuals report being on the lookout for cues of status facilitation and status hindrance. To examine status-relevant appraisals, researchers could measure how much individuals appraise the situation as facilitating or hindering status pursuit. In addition to gathering such self-report data, studies could also benefit from using additional smartphone data, such as participants’ phone calls, text messages, location information, and Bluetooth connections, and they may use smartphones to record snippets of participants’ everyday conversations ( Mehl, 2017 ). These valuable data can allow researchers to examine, for example, situation selection (e.g., where, or with whom, a person was) or interpersonal status-pursuing behaviors (e.g., whether they were bragging about themselves or spreading gossip about others; Harari et al., 2016 ). Combined with peer reports and direct observations, these data could add another layer of information regarding when individuals engage in admiration and when individuals engage in rivalry, as well as on the social consequences of these behaviors.

Our model also suggests that if individuals engage in these status-pursuing processes repeatedly, then these processes might crystallize into traits over time. Thus, the more individuals engage in the processes associated with admiration, the more likely they might be to develop higher levels of trait admiration over time. Likewise, the more individuals engage in the processes associated with rivalry, the more likely they might be to develop higher levels of trait rivalry over time. To test the long-term development of individual differences in admiration and rivalry, researchers should examine whether the proposed self-regulatory processes (as assessed through intensive longitudinal measurements) mediate long-term changes in admiration and rivalry over weeks, months, or even years. Ideally, such studies should start from early adolescence, when status becomes increasingly important and the transition to high-school enables the formation of new social hierarchies ( Brown, 2011 ), and extend to adulthood, when individual differences in personality tend to become more stable ( Roberts & DelVecchio, 2000 ). This might allow researchers to uncover how individuals might change over time in the way that they pursue status through admiration and rivalry.

Experimental tests of the model

The predictive power of the SPIN model can also be tested through intervention. As the model proposes a sequence of momentary processes underlying status pursuit, experimental interventions (i.e., field experiments) can attempt to change each of those processes to examine their downstream effects on status pursuit (see Hofmann & Kotabe, 2012 ). To be sure, the interventions we refer to are not therapeutic plans or ready-to-implement psychological intervention programs. Our model needs more empirical scrutiny before it can be translated to such plans and programs. Rather, we regard these interventions as tests of the processing steps that our model proposes. For example, if changing narcissistic appraisals affects the way individuals pursue social status (e.g., adopting the admiration pathway instead of the rivalry pathway) in their everyday lives, this would constitute evidence for our model. Researchers should be cautious when designing such interventions. Because status is a fundamental human motive ( Anderson et al., 2015 ), such interventions might be ineffective or even backfire if they are designed in a way that frustrates status pursuit altogether.

Interventions on situation selection rely on the principle that environments, objects, or peers associated with an undesired behavior (e.g., drug use) automatically trigger the motivation to enact it and should thus be avoided ( Anker & Crowley, 1982 ; Farabee, Rawson, & McCann, 2002 ; Ingjaldsson, Thayer, & Laberg, 2003 ; Mahoney & Thoresen, 1972 ). We have proposed that narcissists tend to select public and hierarchical settings because such settings can more easily facilitate status pursuit. In line with existing paradigms, future interventions on situation selection could test whether nudging individuals to select more affiliation-oriented over status-oriented settings in daily life can scale down undesirable instances of status pursuit.

Interventions on vigilance rely on the principle that withdrawing one’s attention from cues that elicit specific responses can scale down those responses. For example, training individuals to withdraw their attention from stress-triggering social cues (e.g., pictures of frowning faces) and to orient it toward emotionally comforting social cues (e.g., pictures of smiling faces) was found to scale down physiological and self-reported stress levels ( Dandeneau, Baldwin, Baccus, Sakellaropoulo, & Pruessner, 2007 ). We have proposed that narcissists tend to pay vigilant attention to cues that indicate whether environments facilitate or hinder their status pursuit. In line with existing paradigms, interventions on narcissistic vigilance could examine whether nudging individuals to withdraw their attention from environmental cues indicating the hindrance of status pursuit can make them less inclined to pursue status via the rivalry pathway.

Appraisals are especially suitable targets for psychological intervention, as they are the most direct precursors of behavior ( Walton & Wilson, 2018 ). Relevant findings support this assumption. For example, encouraging individuals to appraise their elevated arousal during public speaking as a sign of coping rather than as a sign of stress was found to lower physiological and self-reported stress responses ( Jamieson, Nock, & Mendes, 2012 , 2013 ). We have proposed that when narcissists infer that situational demands exceed their perceived resources to self-promote, they may resort to other-derogating behaviors. Following existing paradigms, future interventions on narcissistic appraisals could teach individuals to reappraise status-related setbacks as learning experiences that will strengthen their future status pursuits. For example, interventions could teach individuals to reappraise critical feedback not as a sign of their incompetence but as a set of suggestions that indicate how to improve their competence (for a similar rationale, see Dweck & Leggett, 1988 ; Yeager, Trzesniewski, & Dweck, 2013 ). Such interventions might eventually lead individuals to reappraise demanding situations as facilitating (rather than hindering) status pursuit, scaling down the appraisals leading to other-derogating behaviors.

Interventions targeting response execution (i.e., focusing on direct behavioral change) are usually aimed at rewarding desirable behaviors and at ignoring or punishing undesirable behaviors ( Anker & Crowley, 1982 ). Because social settings usually provide these rewards and punishments, we suggest that interventions on narcissistic response execution might be more effective if they target the social settings rather than the individuals within those settings. Individuals might be reluctant to abandon behaviors if these behaviors are still rewarded by their social setting. Interventions could alter the means through which individuals pursue social status, such as by affording status through prosocial acts. For example, school-wide interventions in which groups of students took a public stance against conflict (e.g., by giving public rewards, such as wristbands, to peers who engaged in friendly or conflict-mitigating behaviors) were found to reduce conflict behavior at the school level ( Paluck & Shepherd, 2012 ; Paluck, Shepherd, & Aronow, 2016 ). Similar interventions can also be developed for other settings, such as organizational ones (e.g., through organizational campaigns that afford status on the basis of collaboration rather than competition). Another way of promoting behavioral change is by altering institutional policies to promote collaborative over competitive activities (see Tankard & Paluck, 2016 ). As a result, individuals may become more oriented toward “getting along” than “getting ahead,” thus toning down their pursuit of social status.

We proposed longitudinal and experimental methods to validate our model. Intensive longitudinal studies should repeatedly measure each self-regulatory process of the model to uncover when and why individuals engage in admiration or rivalry in their daily lives and how individual differences in such status pursuit might, over time, crystallize into relatively stable individual differences changes in narcissism. Experimental interventions should examine whether experimentally manipulating one of the model processes can change narcissistic status pursuit.

Combining evolutionary accounts of social behavior with existing accounts of narcissism, we illustrated why and how narcissism is a system of psychological processes and behaviors aimed at fulfilling individuals’ fundamental motive for social status. Placing a social motive at the center of narcissism allows for a better understanding of why narcissistic beliefs and behaviors have a social orientation, improving our understanding of why social relationships can be central in the development and reinforcement of narcissism. By pinpointing the self-regulatory processes of status pursuit and how narcissists engage in these processes, our model connects the literature on narcissism with the broader literature on personality development. The model provides a theoretical framework for studies into the similarities and dissimilarities of narcissism with other personality traits and for the development of precise interventions to curb socially undesirable aspects of narcissism.

1. Some researchers suggest a process that follows situation selection, termed “situation modification.” Situation modification is the process of altering a situation to align with one’s goals. Because situation modification refers to actions taken within a situation, we discuss its associated behaviors under the “response execution” umbrella.

Action Editor: Laura A. King served as action editor for this article.

Declaration of Conflicting Interests: The author(s) declared that there were no conflicts of interest with respect to the authorship or the publication of this article.

Home > Theses > THESES1 > 1283

University of Wollongong Thesis Collection 2017+

The impact of narcissistic personality disorder on others: a study of romantic partners and family members.

Nicholas J. S Day , University of Wollongong

Degree Name

Doctor of Philosophy

School of Psychology

Narcissistic personality disorder (NPD) is a diagnosed mental health disorder that affects up to 6.2% of the population. NPD is known to have a strong interpersonal component, as individuals express their vulnerabilities to others in ways that are challenging. For instance, a person may sometimes seem grandiose and prone to intense hostility, but at other times seem vulnerable and needy, yet difficult to please. However, while the presence of interpersonal dysfunction has been identified for individuals with NPD, little is known about how this is experienced by partners and family members. This thesis presents four original studies on the impact of NPD on romantic partners and family members to progress our understanding of the disorder and improve treatment.

Method: The thesis begins with a critical review of existing literature regarding the construct of NPD to determine new research questions to be addressed (Chapter 1). Chapter 2 presents a study of partners and family in a close relationship with someone with NPD (N = 683) to assess levels of grief, burden, coping and mental health. Thematic analysis of a subset of participants' qualitative descriptions of their relative was conducted (N = 436), exploring the characteristics of the NPD relative (chapter 3) and their interpersonal interactions (chapter 4). Finally, some participants (N = 15) were asked to provide detailed narratives comparing their relationships with their relative and with others (chapter 5), to study core conflictual relationship themes (CCRTs). Chapter 6 provides an overview of research findings and outlines implications for the assessment, diagnosis and treatment of individuals with NPD, but also targeted therapeutic supports for partners and family members.

Results: Participants living with a relative with NPD were suffering significant psychological symptoms (69% depression, 82% anxiety) and high burden (chapter 2). Levels of symptoms and burden were higher than individuals living with people diagnosed with borderline personality disorder or other severe mental illness. Participant’s descriptions of their relative (chapter 3) included both “grandiose” tendencies (including entitlement, envy and exploitativeness) but also “vulnerable” ones (including hypersensitivity, insecurity and emptiness). The relationship included themes of coercive control (chapter 4), where the relative made challenging physical, verbal, emotional, financial and sexual demands. Fluctuations in idealisation, devaluation, hostility, and dependency were often present in the relationship. Relationship narratives involving relatives with pathological narcissism involved more instances of disharmony, including relatives rejecting, subjugating and attacking behaviours, and participants rejecting and withdrawing behaviours, corresponding with a deactivation of participants attachment system (chapter 5).

Conclusion: Living with a person with NPD appears to inflict a considerable psychological toll on those closest to the person. While narcissistic grandiosity, coercive control and interpersonal antagonism may serve to protect the individual who is suffering, these have an insidious effect on partners and family members. Treatments for NPD are limited, with no randomised controlled trials. The findings presented here have two major implications for therapy. First, that the disorder has severe impacts on others, meaning the mental health needs of close relatives should be assessed. Second, that therapists will need specific, targeted support to help them work with individuals with NPD, to help navigate fluctuations of grandiosity and vulnerability in this patient group, sometimes prone to being coercive, controlling and hostile, whilst also presenting as needy and insecure.

Recommended Citation

Day, Nicholas J. S, The impact of narcissistic personality disorder on others: A study of romantic partners and family members, Doctor of Philosophy thesis, School of Psychology, University of Wollongong, 2021. https://ro.uow.edu.au/theses1/1283

FoR codes (2020)

520302 Clinical psychology

Since March 09, 2022

Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.

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Narcissism’s Identifying and Understanding Essay

Defining narcissism, cause of narcissism, effects of having the disorder, treating narcissism, people who can treat narcissism, diagnosis of the disease, the relationship between the disorder and the effect of the parenting.

A narcissistic personality disorder is a mental problem where an individual develops a feeling that he or she is superior to other members of society. People who suffer from this disorder tend to look down upon other members of society. They would prefer using others to their own benefit and disregard the need to respect others or the law. Although there are no known biological causes of this disease, many medical practitioners have related it to poor parentage, where children are made to feel superior to other members of society. If left untreated, patients suffering from this disease may suffer from a series of social problems. They may not be able to have sustainable relationships in their lives. They may also react aggressively whenever they are criticized by anyone in society. In order to treat this disease, psychologists and physicians have always recommended the use of psychotherapy in order to correct the mental disorder.

Narcissism is a personality disorder that is a state of mind where an individual develops a feeling of superiority over others within a given social setting. Paris (2013) defines narcissism as “A mental disorder in which people have an inflated sense of their own importance and a deep need for admiration.” As seen in this definition, this is a mental disorder where an individual feels overly superior to others in all spheres. They develop a strong sense of self-appreciation, always feeling superior to others in society. It is important to understand that narcissism is different from self- esteem or egocentric feelings. It goes beyond the two.

It is a strong feeling of self-superiority that makes one feel that others are objects that do not deserve any form of attention. The fact that this feeling makes one despise others and over-value self is what makes it a disorder. People suffering from the disorder cannot relate with other members of the society in a proper way because they will always be feeling that they are mere objects. These people are also hypersensitive to any form of criticism. Because they feel superior to others, they may not take any form of criticism from people. They can react violently when criticized, or be withdrawn, a fact that will affect their quality of life.

It is necessary to understand some of the causes of this disorder in order to determine how to address it at its earliest onset. According to Pallone (2005), there are no known biological causes of narcissism. This scholar associates narcissism with complex dysfunction in childhood. Most of the scholars have only identified risk factors that may be associated with the disease. One of the risk factors may be excessive pampering by parents during early childhood and late into adolescence. Extreme expectations from the victims or people around the victim over him or her may also cause narcissism. Some scholars have always associated this mental disorder with neglect or abuse during early childhood, while others relate it to genetic causes. Excessive praise from others, unpredictable caregiving, oversensitive temperament, and manipulative behavior of the parents or guardians may also lead to this mental disorder.

A narcissistic personality disorder may have serious effects on the victim, especially if it is not addressed adequately at its early stages. One of the main effects of this disorder is that it makes it difficult for an individual to have a positive relationship with peers and other members of society. According to Pallone (2005), no one likes being viewed as an object. When an individual despises other members of the society, what he or she is likely to receive out of this is a strong feeling of resentment and despise from others. This may have a serious negative impact on one’s social life. Such an individual may be forced to lead a solitary life because everyone would try to avoid them.

DuBrin (2012) notes that, people with narcissistic personality disorder, may find it difficult to obey laws, rules and regulations. This means that, at school, such individuals may find it difficult to obey their teachers and other authorities because they will always consider themselves above the law. In a society, they may have problems in obeying the law because they will always consider themselves superior to everyone. Another effect of narcissism is the inability to accept criticism from others. These individuals always feel superior to others, and do not expect any form of criticism from them. They will always view such criticism as a way of looking down upon them despite their superior nature. This may make them withdrawn or act violently against the critics. If people suffering from this mental disorder ascend to position of leadership, it may be extremely difficult to offer them guidance when they make mistakes. They will always make their words to be law irrespective of how unreasonable they may be before the society.

It is important to offer treatment to the victims of this disorder as soon as it is diagnosed in order to avoid further effects it may have on them. According to Banja (2005), the main medication that a patient suffering from this disorder may get is psychotherapy. This is because it is a mental disorder that may not be treated by offering medications to the patient. A number of therapies may be offered to the patient depending on the stage of the disorder in order to address it adequately. Cognitive behavioral therapy may be necessary to help the patient identify negative unhealthy beliefs and behavior that is undesirable in the society. These beliefs will need to be replaced with a positive attitude in the society where one learns to appreciate every member of the society. Family therapy may also be necessary to supplement cognitive behavioral therapy. Family therapy would involve exploring issues such as communication problems, conflict management, and problem solving skills.

Parents can play an important role in this by making their children realize that they are just as good as other members of the society. They should be made to believe that no one is too superior to others to be able to relate with everyone positively. Group therapy may also be important, especially if the group consists of people with a similar condition. The psychotherapist may work with the group to make them appreciate the equality of every member of the society, and the need to treat everyone with a sense of decorum. It is important to note that, at times, these patients may develop anxiety and depression if the condition is not addressed in time. Anxiety and depression may be managed using anti-anxiety and antidepressant medications.

Treating of this disorder needs experts who can be able to diagnose the condition and prescribe appropriate medication. Psychotherapists are in the best position to detect this disorder and prescribe the best approach of treatment. They are expected to conduct the cognitive behavioral therapy. They are also expected to guide the process of family or group therapies. In cases where the patient is suffering from any form of physical pain caused by the anxiety or depression, then physicians may be of great help.

The diagnosis of narcissism can be conducted by either analyzing its signs and symptoms, or by conducting a psychological evaluation. According to Welt & Herron (2001), the Diagnostic and Statistical Manual of Mental Disorders may be necessary in order to conduct a diagnosis of this disorder. There will be a number of issues that will need to be detected in the patient before a conclusion can be made to confirm that the patient is suffering from the disease. Exaggerated sense of importance, preoccupation with success, and the belief that one is special are some of the signs of this disorder (Meier, Charlebois, & Munz 2009).

People with constant self-admiration, sense of entitlement, the need to use others, or inability to appreciate others needs could also be a further pointer that one could be suffering from this complication. Others may develop serious envy towards others they consider more successful than them, the fact that may make them behave arrogantly. It is important to identify these symptoms during diagnosis because they are pointers that one could be suffering from this mental disorder.

According to Pallone (2005), there is a close relationship between this mental disorder and the effect of parenting. Although there are no known biological causes of this disease, medical practitioners have associated it with the kind of upbringing a child gets during early stages of development. According to Paris (2013), a child that is excessively pampered by the parents may get this disorder because they are made to believe that they are special over their peers. They develop knowing that they superior, and with time, this feeling turns into a serious mental disorder of narcissism. Some psychologists have also related the bullish nature of some parents to this disorder.

Parents who constantly mistreat others or make them feel inferior to them in the presence of their children are likely to pass the disorder to their children. Such children will develop knowing that there are those who are inferior to others. They will want to emulate their parents and be the superior members of the society. To achieve this, they will try to act as their parents, abusing their peers, and viewing others as lesser beings.

According to the research the research by DuBrin (2012), parents who neglect their children are also likely to blame for this mental disorder. Children who are neglected by their parents may develop this disorder, especially when they are subjected to various forms of abuses (Goodman, Goodman, & Leff 2011). They develop the disorder as a self-defense mechanism. The disorder comes as a way of forcing other members of the society to accept them. This means , there is a direct relationship between the disorder and the effect of parenting.

Banja, J. D. (2005). Medical errors and medical narcissism . Sudbury, Mass: Jones and Bartlett Publishers. Web.

DuBrin, A. J. (2012). Narcissism in the workplace: Research, opinion and practice . Cheltenham, UK: Edward Elgar. Web.

Goodman, M. E. C. L., Goodman, M. D. C. L., & Leff, L. B. (2011). The Everything Guide to Narcissistic Personality Disorder: Professional, Reassuring Advice for Coping with the Disorder – At Work, at Home, and in Your Family . Holbrook: F+W Media. Web.

Meier, P. D., Charlebois, L., & Munz, C. (2009). You might be a narcissist if: How to identify narcissism in ourselves and others and what we can do about it . Minneapolis, MN: Langdon Street Press. Web.

Pallone, N. J. (2005). Altruism, narcissism, comity: Research perspectives from Current psychology . New Brunswick, N.J: Tranaction Publishers. Web.

Paris, J. (2013). Psychotherapy in an age of narcissism: Modernity, science, and society . S.l: s.n.. Web.

Welt, S. R., & Herron, W. G. (2001). Narcissism and the psychotherapist . New York: Guilford Press. Web.

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Home > Theses, Dissertations, and Projects > 1133

Theses, Dissertations, and Projects

A critical examination of the theoretical and empirical overlap between overt narcissism and male narcissism and between covert narcissism and female narcissism.

Lydia Onofrei , Smith College

Publication Date

Document type.

Masters Thesis

School for Social Work

Narcissism, Narcissism-Sex differences, Men-Psychology, Women-Psychology, Overt narcissism, Covert narcissism, Gender and narcissism, Sex and narcissism, Grandiosity, Idealization, Women/female, Men/male, Megalomania, Feminine beauty (Aesthetics)

Within the past twenty years, there has been a proliferation of empirical research seeking to distinguish between overt and covert types of narcissism and to elucidate the differences between narcissistic pathology among men and women, yet these two areas of research have largely been carried out independently of one another in spite of clinical observations suggesting a relationship between them. This project was undertaken to systematically examine whether an overlap exists between the clinical category of overt narcissism and male/masculine narcissism, or between the category of covert narcissism and female/feminine narcissism. Secondly, it sought to elaborate on areas of overlap between these categories. Contemporary theoretical conceptualizations of narcissism and overt and covert types were presented, followed by a review of empirical research examining grandiosity/idealization, shame, self-esteem, and dominance and exploitativeness among overt and covert narcissists. Theories on gender and narcissism were then presented, followed by a review empirical research in the four categories previously listed. Areas of overlap with respect to both theory and research were identified and discussed. The findings suggest that both overt and male/masculine narcissists are marked by a greater tendency toward openly displayed grandiosity, whereas covert and female/feminine narcissists show a greater tendency toward idealization. Exploitativeness was found to be higher among overt and male narcissists than among covert and female narcissists; however, support for the later finding was mixed. The findings also indicated that whereas shame and self-esteem differ quantitatively between overt and covert types, differences between men and women in these areas are qualitative

iii, 77 p. Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2009. Includes bibliographical references (p. 74-77)

Recommended Citation

Onofrei, Lydia, "A critical examination of the theoretical and empirical overlap between overt narcissism and male narcissism and between covert narcissism and female narcissism" (2009). Masters Thesis, Smith College, Northampton, MA. https://scholarworks.smith.edu/theses/1133

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Narcissistic Personality Disorder: Diagnostic and Clinical Challenges

• Eve Caligor , M.D. ,
• Kenneth N. Levy , Ph.D. ,
• Frank E. Yeomans , M.D., Ph.D.

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“Mr. A” is a 42-year-old married man presenting to a private-practice psychotherapist complaining of problems with his wife. He is a successful entrepreneur, highly competitive, who describes enjoying social gatherings, where he tends to be the center of attention, as well as challenges at work, where he believes that he has a superior ability to solve problems. He comes to treatment because he is wondering whether or not to stay in his marriage. Mr. A described having lost all sexual interest in his wife during their early years together. Throughout the marriage, he has maintained a series of lovers whom he has housed, supported, and then cut off and replaced. He feels that this arrangement has had no impact on his relationship with his wife but wonders if he would do better with someone else.

“Mr. B” is a 34-year-old single man with a history of cocaine and alcohol abuse, currently unemployed. He presented to the emergency department complaining of pain following a dental procedure and requesting Percocet (acetaminophen and oxycodone). Although he was initially ingratiating with the attending physician who took his history, when she explained that she would have to speak with his oral surgeon before writing a prescription for a narcotic, Mr. B began to insult and bully her. The attending spoke with Mr. B’s “girlfriend,” whose contact information he had provided. The girlfriend explained that she had recently broken things off with Mr. B because he had been exploiting her financially; since being fired 1 year earlier from a high-paying financial job, he had been unable to find employment that met his lofty expectations for himself, preferring instead to live off money from his father and his girlfriend.

“Mr. C” is a 29-year-old single man with a history of insulin-dependent diabetes who presents to an outpatient clinic for treatment of dysthymia and social phobia. He has held a series of low-level jobs that “have not worked out,” and he currently works part-time doing data entry. Mr. C described his mood as chronically “miserable.” Socially isolated and easily slighted, he has no interests, takes pleasure in nothing, and routinely wonders “whether life is worth living.” When feeling down, he often “forgets” to administer his insulin, resulting in multiple hospitalizations for hyperglycemia. He constantly compares himself with others, feeling envious and resentful, and describes himself as deficient and defective. At the same time, he resents that others fail to recognize all he has to offer. At times he engages in fantasies of his employer publicly acknowledging his special talents and promoting him; at other times, he has fantasies of humiliating his boss with a display of superior knowledge.

“Ms. D” is a 44-year-old single woman referred to a group specializing in severe personality disorders. She complained of “refractory depression” for which she was on medical disability. She had been treated for 10 years with every modality her local hospital could offer, including ECT. She portrayed her previous therapists in scathingly derogatory terms, seeming to find gratification in their failed attempts to help her. Her group therapist diagnosed her with narcissistic personality disorder based on the gap between her self-image as an extremely gifted but unrecognized author and the reality that she had written almost nothing. Antisocial features consisted of chronic lying, a history of prostitution in her 20s, and “working the system” to obtain disability payments rather than taking on work that she was able to do. There were no neurovegetative symptoms of depression. When her new therapist raised the possibility of working toward employment, Ms. D coolly declared that she would kill herself, or him, if he interfered with her ability to obtain her benefits.

Narcissistic personality disorder is prevalent, highly comorbid with other disorders, and associated with significant functional impairment and psychosocial disability ( 1 , 2 ). However, it has been one of the least studied personality disorders. As a result, there is a fair amount of confusion regarding the reliability, validity, specificity, and sensitivity of diagnostic criteria, as well as the prevalence of the disorder, and to date there have been no randomized clinical trials examining the efficacy of any treatment for the disorder ( 3 ). In fact, because of the limited research literature, narcissistic personality disorder was initially slated to be omitted from DSM-5. However, in response to feedback from the clinical and research community (e.g., 4 – 8 ) this decision was reversed, and narcissistic personality disorder was included in Section II of DSM-5 (Diagnostic Criteria and Codes) and also reconstructed in Section III (Emerging Measures and Models).

Definition and Diagnostic Challenges

Diagnostic confusion surrounding narcissistic personality disorder reflects the disorder’s highly variable presentation and the wide range of severity that can characterize narcissistic pathology. Individuals with narcissistic personality disorder 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. Given this heterogeneity, it is far from self-evident what such individuals could have in common to justify a shared diagnosis. The DSM-5 criteria ( Table 1 ) to some degree sidestep this question by providing a rather narrow and homogeneous definition of narcissistic personality disorder characterized by a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, entitlement, and lack of empathy. However, while these criteria capture important aspects of narcissistic pathology, they provide inadequate coverage of the broad population of individuals who receive the diagnosis in clinical practice ( 9 – 11 ), and they fail to cover core psychological features of the disorder, including vulnerable self-esteem; feelings of inferiority, emptiness, and boredom; and affective reactivity and distress ( 11 ). Furthermore, because DSM-5 criteria are, a priori, limited to observable features of psychopathology, the description of narcissistic personality disorder in Section II of DSM-5 does not address underlying psychological structures or dynamic constellations that can be seen to organize and unify the various presentations of the disorder.

a Reprinted from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition . Arlington, Va., American Psychiatric Association, 2013, pp. 669–670. Copyright 2013, American Psychiatric Association. Used with permission.

TABLE 1. DSM-5 Criteria for Narcissistic Personality Disorder a

Subtypes and Core Psychological Features

Although DSM-5 describes a single, relatively homogeneous syndrome, there is a rich literature supporting the existence of different subtypes of narcissistic personality disorder ( 12 – 22 ). The clinical vignettes we provide here of four patients diagnosed with narcissistic personality disorder illustrate both the variable presentation of the disorder with regard to descriptive features (“subtypes”) and the broad spectrum of severity of pathology associated with the disorder. Typical presentations of narcissistic personality disorder are the grandiose, “overt,” subtype, corresponding closely to the DSM-5 criteria and illustrated in the vignettes by Mr. B; the vulnerable, “covert,” subtype, less well covered in current diagnostic criteria, illustrated by Mr. C; and the healthier, “high-functioning” subtype illustrated by Mr. A.

The grandiose, thick-skinned, overt subtype is characterized by overt grandiosity, attention seeking, entitlement, arrogance, and little observable anxiety. These individuals can be socially charming, despite being oblivious to the needs of others, and are interpersonally exploitative. In contrast, the vulnerable, “fragile” or thin-skinned, covert subtype is inhibited, manifestly distressed, hypersensitive to the evaluations of others while chronically envious and evaluating themselves in relation to others. Interpersonally these individuals are often shy, outwardly self-effacing, and hypersensitive to slights, while harboring secret grandiosity. Both types are extraordinarily self-absorbed. Many individuals with narcissistic personality disorder fluctuate between grandiose and depleted states, depending on life circumstances, while others may present with mixed features ( 11 , 15 , 17 , 22 ). In addition to the grandiose and vulnerable subtypes, there is a healthier group of individuals with narcissistic personality disorder, described as “high-functioning,” “exhibitionistic,” or “autonomous.” These individuals, illustrated by Mr. A, are grandiose, competitive, attention seeking, and sexually provocative, while demonstrating adaptive functioning and using their narcissistic traits to succeed. Because of their high level of functioning, at first glance individuals in this group may not appear to have a personality disorder, and the narcissistic personality disorder diagnosis can be overlooked on diagnostic assessment.

An appreciation of the various subtypes of narcissistic personality disorder leads to the question of what are the core psychological features that define narcissistic personality disorder and that can in turn be relied upon to inform clinical assessment and treatment planning. This issue is addressed to some degree in the alternative model for conceptualizing personality disorders developed by the DSM-5 Work Group and included in Section III of DSM-5. This model goes beyond the familiar focus on the descriptive features of different personality disorders to emphasize additionally the role of impairment of self and interpersonal functioning in personality pathology. For narcissistic personality disorder, Section III identifies deficits in self-definition, self-esteem and affect regulation, and consolidation of internal goals and standards as core features of the disorder; interpersonal relations are “functional,” serving to support the sense of self and/or to provide personal gain, and capacity for intimacy is lacking ( Table 2 ).

a Reprinted from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition . Arlington, Va., American Psychiatric Association, 2013, pp. 767–768. Copyright 2013, American Psychiatric Association. Used with permission.

TABLE 2. Proposed Criteria for Narcissistic Personality Disorder in the Alternative DSM-5 Model for Personality Disorders a

Our own approach to characterizing and understanding narcissistic personality disorder is compatible with the alternative model developed by the DSM-5 Work Group and also with psychodynamic models of narcissistic personality disorder based in object relations theory. From a psychodynamic perspective, a specific form of self or identity dynamic is at the core of narcissistic pathology ( 15 ). Rather than the flexible and reality-based self-experience that characterizes normal identity formation, the sense of self in narcissistic personality disorder is brittle and somewhat removed from reality; what characterizes narcissistic personality disorder across the spectrum is a more or less fragile sense of self that is predicated on maintaining a view of oneself as exceptional. This characterization applies not only to grandiose narcissists, but also to those in the vulnerable subtype, where grandiosity is cloaked in feelings of inferiority and deficiency. Maintaining a grandiose sense of self can provide a more or less stable self-experience for the individual with narcissistic personality disorder, but comes at a cost, requiring a retreat from or denial of realities that do not support grandiosity, and leaving the individual excessively reliant on external feedback to support not only positive self-regard but also self-definition. The specific pathology of identity formation that characterizes narcissistic personality disorder also lends itself to characteristic disruptions in interpersonal functioning. On the one hand, individuals with narcissistic personality disorder often have a profound need for others to support their sense of self and also to help with self-esteem regulation. On the other hand, genuine engagement with others can threaten the stability of the grandiose sense of self, by confronting the individual with the painful reality that others have attributes that they lack. As a result, those with more grandiose features tend to engage in superficial relationships organized to support self-esteem and self-definition, while those with more vulnerable features tend to withdraw from social situations; for both types, self-regulatory needs leave little room for genuine interest in the needs or feelings of others.

Prevalence and Comorbidity

The prevalence of narcissistic personality disorder remains poorly defined, reflecting the lack of clarity around the diagnosis. Commonly cited prevalence estimates range from 0% to 5.3% in the general population ( 11 ). Prevalence in clinical samples has been reported to range from 1% to 17% ( 11 ). In a recent large adult community sample, risk factors included male sex, younger age, and single marital status ( 2 ).

Narcissistic personality disorder is frequently comorbid with other disorders, particularly substance use disorders, bipolar disorder, and other personality disorders ( 2 , 23 , 24 ), and comorbid disorders are often what first brings individuals with narcissistic personality disorder to clinical attention. The degree of comorbidity is linked to severity ( 25 ). Narcissistic personality disorder most commonly co-occurs with antisocial, histrionic, borderline, schizotypal, and passive-aggressive personality disorders ( 3 ); comorbidity with antisocial personality disorder has the most profound negative impact on prognosis.

Grandiose and vulnerable narcissistic subtypes are associated with different patterns of comorbidity ( 22 ). Depression and anxiety are more common in the vulnerable narcissistic group, as are nonsuicidal self-injury and suicide attempts ( 16 , 17 , 19 ). In contrast, those with the grandiose subtype or in grandiose states may be relatively free of subjective distress unless confronted with professional or interpersonal failures ( 15 , 18 ). Grandiose traits tend to be related to substance abuse and comorbidity with antisocial and paranoid personality disorder ( 19 ).

Clinical Presentation and Clinical Challenges

Individuals with narcissistic personality disorder constitute some of the highest-functioning patients seen in outpatient settings and also some of the most impaired and intractable among patients seen in emergency departments and on inpatient units. In fact, of all the personality disorders, narcissistic personality disorder spans the broadest spectrum of severity ( 15 ). As a result, it is useful to distinguish not only between grandiose/overt and vulnerable/covert clinical presentations, but also among different levels of severity of narcissistic personality disorder. In general, as severity of narcissistic pathology increases, aggression, which can be directed at oneself as well as others, becomes more evident, interpersonal functioning deteriorates, and deficiencies in moral functioning become increasingly prominent, posing significant challenges to clinical management ( 26 , 27 ). More severe forms of narcissistic personality disorder challenge clinicians to limit patients’ destructive and self-destructive behavior. In addition, it is necessary to minimize secondary gain (benefits derived from being ill), which often involves insisting that patients seek appropriate employment and may require involvement of family members in treatment.

At the highest level of functioning, patients like Mr. A are able to achieve the admiration necessary to gratify their grandiose needs. These individuals may function successfully, although they may be susceptible to breakdowns in response to setbacks or advancing age. Like Mr. A, psychopathology may be evident primarily in a transactional view of intimate relations, which are characterized by superficiality and lack of genuine concern for the needs or the feelings of the other. Individuals in this group rarely seek treatment; when they do, it is often only at the insistence of significant others or during an acute crisis.

At the middle level of functioning, patients like Mr. B present with an obviously distorted, grandiose sense of self and have little interest in intimacy. These individuals may function adequately or even well professionally, despite significant interpersonal difficulties, or they may refuse to work, especially if they do not have access to narcissistically gratifying employment. Mr. B demonstrates grandiosity in his refusal to take on work he sees as beneath him, preferring to be unemployed, entitlement in his demands for medication in the emergency department, and financial exploitation of his parents and girlfriend. Problems in his sense of self are joined with a view of others as a means to an end rather than a source of mutual gratification. Motivation for treatment can be limited; Mr. B would likely have no interest in treatment unless his family demanded it as a condition of continued financial support.

At a lower level of functioning are patients like Mr. C, who present with comorbid borderline personality traits. In contrast to the higher-functioning group, these individuals exhibit a sense of self that is poorly defined and unstable; they frequently oscillate between pathological grandiosity and suicidality. Mr. C demonstrates self-directed aggression in his noncompliance with diabetes care, antisocial features to the extent that he misrepresents the cause of his hyperglycemia to his physicians, and extremely poor interpersonal functioning characterized by a lack of interest in relationships. In addition to demonstrating features of lower-level narcissistic pathology, Mr. C presents the challenge of vulnerable narcissism, appearing submissive and inadequate, but with a self-concept based on a covert sense of superiority. The gap between an unrealistic and extremely fragile sense of self and objective reality leads to a lack of engagement in the world, as any meaningful contact with others (including treatment providers) challenges his covert grandiosity.

Finally, at the greatest level of severity are those like Ms. D who suffer from “malignant narcissism” ( 28 ). The illnesses of these patients are characterized by the typical symptoms of narcissistic personality disorder; however, these patients also display prominent antisocial behavior, tend toward paranoid features, and take pleasure in their aggression and sadism toward others. Individuals in this group are the most difficult to treat: chronic lying and the sadistic pleasure in controlling and even frightening and intimidating clinicians can overwhelm any possibility of working therapeutically. In addition, secondary gains, which can be financial or interpersonal, provide a powerful motivation for the patient to maintain the status quo; often there is no hope for change unless the treatment team works with the patient’s social system to limit or eliminate secondary gain.

Because of the sometimes subtle presentation of narcissistic personality disorder, especially at the higher-functioning end of the spectrum, and because of the centrality of interpersonal difficulties in the disorder, a systematic clinical interview may be the most reliable way to diagnose narcissistic personality disorder. Kernberg’s structural interview ( 29 ) is one such clinical interview, and it is also available in modified form as a semistructured interview ( 30 ). While structured assessments for narcissistic personality disorder, in both self-report and structured interview formats, have demonstrated reliability and utility for research, they add little to the interview of a skilled clinician.

In the clinical interview, focusing on the patient’s description of significant others can help in diagnosing narcissistic personality disorder. These descriptions are characteristically dismissive or derogating or, alternatively, colored by idealization. Most striking, however, is the markedly superficial and vague, shadowy quality of the narcissistic individual’s experience of others. In addition, individuals with narcissistic personality disorder demonstrate a tendency to describe others in terms of how others are similar to or different from themselves. In contrast, the narcissistic individual’s sense of him- or herself may be more intact and nuanced, albeit colored by grandiosity or self-deprecation. The clinician’s personal reactions to the individual with narcissistic personality disorder can call attention to the diagnosis. Common reactions to patients with narcissistic personality disorder include feeling idealized and pressured to provide a magic cure, feeling belittled and devalued, feeling treated like someone who is incompetent and has nothing to offer, or feeling like a sounding board, ignored, without recognition of the clinician as an individual or any interest in what he or she might have to say ( 19 , 31 , 32 ).

Differential Diagnosis

The differential diagnosis for narcissistic personality disorder includes bipolar illness, substance abuse, depressive disorders, especially treatment refractory depression, and anxiety disorders, as well as other personality disorders. All are frequently comorbid with narcissistic personality disorder, complicating diagnostic and clinical decision making; it is often unclear whether symptoms of anxiety or depression, for example, reflect a comorbid diagnosis or are primarily an expression of personality pathology. While manic states can mimic many of the features of grandiose narcissism, the admiration seeking and devaluation of others characteristic of narcissistic personality disorder are typically absent in manic individuals. One can imagine that Mr. A, when excited by a new business idea, might demonstrate the kind of expansiveness and exuberant enthusiasm seen in hypomania. In this setting, his need to have his superior creativity and effectiveness admired by others would help to distinguish his behavior from that of someone who is hypomanic. Chronic substance abuse can affect psychological functioning to simulate narcissistic personality disorder; the individual with a chronic substance use disorder may become exploitative, self-focused, lacking in empathy, and ruthless, often in conjunction with antisocial features. This syndrome could potentially be at play with Mr. B, and establishing the narcissistic personality disorder diagnosis would require careful assessment of his substance abuse history as well as of his personality functioning across time. Symptoms associated with major depression, dysthymia, social anxiety, and generalized anxiety disorder overlap with features of vulnerable narcissism. In this setting, one can avoid missing the narcissistic personality disorder diagnosis by careful evaluation of the patient’s sense of self and interpersonal functioning. For example, despite Mr. C’s complaints of depression and social anxiety, his covert grandiosity is incompatible with a diagnosis of a major affective or anxiety disorder alone. Similarly, Ms. D’s grandiosity and entitlement do not fit with the diagnosis of major depression, despite her many years of treatment. In addition, the absence of all meaningful relationships demonstrated by both Mr. C and Ms. D would be difficult to account for on the basis of depression and anxiety.

The personality disorders most commonly in the differential diagnosis for narcissistic personality disorder are histrionic, borderline, and antisocial. It is the characteristic grandiosity and need for admiration that most clearly distinguish narcissistic personality disorder from these other diagnostic groups. Narcissistic personality disorder and borderline personality disorder can be further distinguished by the relative instability of the sense of self, along with the impulsivity and self-destructiveness of borderline personality disorder. Mr. C, who presents with comorbid borderline and narcissistic personality disorders, illustrates these features. Histrionic personality disorder and narcissistic personality disorder are both characterized by the need to be the center of attention, but individuals with histrionic personality disorder have a greater capacity for dependent relations than do those with narcissistic personality disorder, and they are more emotionally expressive and less dismissive of others. Despite his superficially good interpersonal functioning and attention seeking, Mr. A can be distinguished from the individual with histrionic personality disorder on the basis of his callous and self-serving attitude toward the women in his life, his lack of overt emotionality, and his view of himself as exceptional. Antisocial personality disorder and narcissistic personality disorder share the traits of exploitation, superficiality, and lack of empathy, but even at the more severe end of the spectrum, individuals with narcissistic personality disorder do not demonstrate the total breakdown of moral functioning and absence of any capacity for loyalty that typifies antisocial personality disorder, nor is narcissistic personality disorder typically associated with the history of childhood conduct disorder that is common in antisocial personality disorder.

The efficacy of psychotherapeutic and psychopharmacological treatment approaches for narcissistic personality disorder has not been systematically or empirically investigated ( 3 ). Clinical practice guidelines for the disorder have yet to be formulated, and psychopharmacologic intervention is symptom driven. Regardless of severity, the grandiosity and defensiveness that characterize narcissistic personality disorder militate against acknowledging problems and vulnerabilities and make engagement in any form of psychotherapy difficult ( 33 ).

In patients presenting with major psychiatric disorders, co-occurring narcissistic personality disorder is known to increase the likelihood of treatment dropout and may slow symptom change ( 34 , 35 ). With this group of patients, discussion of diagnostic issues, including the contribution of personality pathology to the symptom picture, should precede initiation of treatment. Discussion of personality pathology helps to establish realistic expectations on the part of the patient and opens the door to discussion of treatments for underlying narcissistic pathology. Failure to have this sort of discussion can result in polypharmacy or multiple courses of ineffective treatments devoted to chasing refractory symptoms, as exemplified by the case of Ms. D in the vignettes.

When it comes to treatments targeting narcissistic personality disorder per se, current treatment recommendations are based largely on clinical experience and theoretical formulations. Psychodynamic formulations have led to the proliferation of different treatment approaches, and case reports suggest that these treatments can be effective for some patients. Most influential have been those of Kernberg ( 36 , 37 ) and Kohut ( 38 , 39 ), each of which focuses on clinical developments in the relationship between therapist and patient in long-term psychotherapy. In the absence of empirically supported treatments for narcissistic pathology, it is common practice to utilize efficacious treatments for near-neighbor disorders, typically with treatment modifications based on theoretical and clinical rationales regarding differences in the disorders ( 22 ). Thus, for patients with narcissistic personality disorder, we recommend referral for empirically supported treatments for borderline personality disorder that have adaptations for narcissistic personality disorder. In particular, we recommend mentalization-based therapy ( 40 ), transference-focused psychotherapy ( 41 – 43 ), and schema-focused psychotherapy ( 44 ). All three treatments target psychological capacities thought to underlie and organize descriptive features of narcissistic personality disorder. Dialectical behavioral therapy ( 45 ) is an additional option for patients with comorbid borderline personality disorder and significant self-destructive acting-out behaviors. All are longer-term treatments that require specialized training of practitioners.

Summary and Recommendations

Drs. Caligor and Yeomans receive royalties from American Psychiatric Publishing. Dr. Levy receives royalties from Routledge.

The authors thank their colleagues at the Personality Disorders Institute and the Personality Studies Institute, particularly Drs. Otto Kernberg, Diana Diamond, and Barry Stern. They also thank Jacqueline Proszynski for her assistance with the manuscript.

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Opening statements in Trump's historic trial set to begin Monday after tense day of jury selection

Opening statements are set to begin next week in Donald Trump’s historic criminal trial after the final members of the jury were seated Friday, following a dramatic day in which two prospective jurors broke down in tears, an appeals court judge rejected Trump's request for a stay, and a man set himself on fire in front of the courthouse.

“We’re going to have opening statements on Monday morning. This trial is starting,” Judge Juan Merchan said towards the end of the day, after successfully seating the remaining five alternate jurors that were needed.

The case — the first-ever criminal trial of a former president —will be heard by a panel of 12 jurors and a total of six alternates. It's expected to last roughly six weeks.

The five alternates ultimately selected Friday include an unemployed married woman who’s into art and described herself as not political, an audio professional, a contract specialist, a clothing company executive and a construction company project manager. It took four days of jury selection to find the 18 jurors.

Around the same time the judge declared, "we have our full panel" inside the courtroom in the early afternoon, a man set himself on fire outside the courthouse. The NYPD said the man, identified as Max Azzarello of Florida, later died. He appeared to have had pamphlets describing a conspiracy involving cryptocurrency that he threw around before setting himself ablaze, police said.

Later in the afternoon, Trump's attorneys were in a state appeals court trying again to get an emergency stay of the trial. Trump attorney Cliff Robert argued his client could not get a fair trial in Manhattan, which had been Trump's longtime home before moving to Florida after he was elected president in 2016.

Steven Wu of Manhattan District Attorney Alvin Bragg's office countered that "what the last week has shown is that the jury selection has worked."

"We have 18 ordinary New Yorkers who are ready to serve. It would be unfair to them and the public for this to be delayed further," he argued. The judge rejected Trump's stay request a short time later.  

The jury selection process Friday was especially intense, some potential jurors breaking down in tears and others saying they were too anxious to serve.

The day began with the judge calling up the 22 remaining potential jurors from the previous pool of 96 to answer questions designed to indicate whether they could be fair and impartial about the divisive real estate mogul and presumptive Republican nominee for president.

The first of those potential jurors was dismissed after she said she didn’t think she could be fair. “I have really, really bad anxiety and people have found out where I am,” she told the judge. A short time later, two other potential jurors were dismissed after each told the judge that upon further reflection, “I don’t think I can be impartial.”

Other potential jurors included a married father who said he listens to a podcast called “Order of Man,” which is described on Apple’s website as discussions about “reclaiming what it means to be a man.” Some past guests of the podcast include people who’ve been outspoken in their support of Trump and were highly critical of the civil fraud case New York Attorney General Letitia James brought against the former president. The man, an audio specialist, was chosen as one of the alternates.

Another potential juror was a married fund manager who said he’d done “get-out-the-vote” work for former Secretary of State Hillary Clinton, Trump’s 2016 presidential opponent. Trump and his attorney Todd Blanche passed notes back and forth while that juror was speaking. He was later dismissed after being asked about a 2020 Facebook post where he apparently called Trump “the devil and a sociopath.”

Trump appeared most interested in jurors whose answers offer ambiguity around their personal political views. When one prospective juror said they were a Fox News viewer, Trump cocked his head, then quickly conferred with his lawyer, Todd Blanche.

Another potential juror was a woman who became emotional as she disclosed she'd served two years in prison on drug-related charges, but said she could be "fair and impartial."

During a morning break, Merchan — who'd chided reporters on Thursday for disclosing too much information about potential jurors — said the woman had shared "very personal things about her life" and was "very brave." “I just wanted to encourage the press to please be kind. Please be kind to this person,” the judge said. He later dismissed her, saying she needed a certificate of release to be qualified for service going forward. On her way out, she cheerfully called out, "Good luck!"

Following that juror's departure, the DA's office began its individual questioning of the jurors. One woman, who'd disclosed that her father is lifelong friends with Trump ally turned critic Chris Christie, broke down in tears when prosecutor Susan Hoffinger asked her an innocuous question about the burden of proof in the case. "I feel so nervous and anxious right now. I’m sorry," she responded, bursting out into tears. "I thought I could do this," she said, adding "I wouldn’t want someone who feels this way to judge my case." She was dismissed.

Hoffinger's questioning was followed by Trump attorney Susan Necheles, who asked a potential juror who'd started their own business how she would assess a witness's credibility. The woman then asked to speak to the judge, saying she was "getting anxiety and self-doubt” from Necheles's line of questioning. She was dismissed. 

Necheles later asked another woman — who previously said she was a victim of sexual assault — whether she would hold it against Trump that women outside this case have accused Trump of sexual assault. She said she would not have a problem setting those accusations aside but the judge ultimately excused her, saying, "It’s best to err on the side of caution."

Another man said he has some differences from Trump on his policies but thinks he's “usually awesome.” He was not chosen for the jury.

On his way into court in the morning, Trump again complained the case against him is "unfair," and that the partial gag order preventing him from lashing out at witnesses, prosecutors, court staffers and jurors is not "constitutional." "Everyone else can say whatever they want about me. They can say anything they want. They can continue to make up lies and everything else. They lie. They’re real scum. But you know what? I’m not allowed to speak," he told reporters.

Prosecutors this week asked the judge to fine Trump and hold him in contempt for social media posts that they said violate the gag order. A hearing on the matter is scheduled for Tuesday.

The m a in pa nel of 12 is made up of seven men and five women, including two lawyers, a teacher, a retired wealth manager, a product development manager, a security engineer, a software engineer, a speech therapist and a physical therapist. The foreman — the juror who essentially acts as the leader and spokesperson for the panel — is a married man who works in sales and gets his news from The New York Times, MSNBC and Fox News.

The lone alternate selected Thursday is a woman who works as an asset manager.

Trump vented about the speed of the process in a post on social media shortly after the final jurors were selected, claiming the judge is “‘railroading’ me, at breakneck speed, in order to completely satisfy his ‘friends’.”

Later in the day, Merchan held what's known as a Sandoval hearing . That's a type of hearing designed to let defendants know the scope of questions they could face from prosecutors on cross-examination so they can make informed decisions about whether to take the witness stand in their own defense.

Leaving court on Friday, Trump was asked whether he was still planning to testify and he said he was.

Manhattan District Attorney Alvin Bragg's office disclosed in a court filing that it would like to ask Trump about several items, among them the $464 million civil judgment against him and his company for fraud , the total $88 million verdicts and liability findings for sexual abuse  and  defamation in lawsuits brought by writer E. Jean Carroll and a number of other adverse court rulings over the past few years.

Trump has denied wrongdoing in all the cases and is appealing  the fraud judgment and the Carroll verdicts.

Prosecutors said they want to be able to bring those findings up “to impeach the credibility of the defendant” if he takes the witness stand.

Discussing the findings in the fraud case, prosecutor Matthew Colangelo told the judge it was "hard to think of something that is more squarely in the wheelhouse” for the DA to ask Trump about "than a finding by a judge of persistent and repeated fraud and illegality."

Trump's attorney Emil Bove countered that prosecutors shouldn't be able to breach the topic at all because Trump's appeal is still pending. He made similar arguments over the DA's contention that they should be allowed to ask about a judge's finding that he was untruthful on the witness stand during the fraud trial and had violated a gag order in the case.

“Is it your position that because a case is being appealed or might be appealed, that therefore it can not be used?" Merchan asked the lawyer. "Not necessarily," Bove replied.

The judge said he'd issue his ruling on the dispute on Monday morning.

Trump said last week he  “absolutely” plans to testify , but he is under no obligation to do so.

Asked by Necheles at the end of the day who the DA's first witness would be, prosecutor Joshua Steinglass said they wouldn't inform Trump's team of the person's identity until Sunday, given that Trump has been criticizing some witnesses on social media despite the partial gag order in the case. “And if that should be tweeted, that’ll be the last time we provide that courtesy,” Steinglass said.

Merchan called the DA's position "understandable" and told Necheles "I will not compel them to do anything."

Trump has pleaded  not guilty  to 34 counts of falsifying business records and faces up to four years in prison if he is convicted.

Bragg alleges that Trump falsified records to hide money he was paying his former lawyer Michael Cohen to reimburse him for $130,000 he paid adult film actor Stormy Daniels  near the end of the 2016 presidential campaign. Daniels has claimed she had a sexual encounter with Trump in 2006. Trump has denied that he slept with Daniels, but he has acknowledged repaying Cohen.

The DA’s office also alleges that as part of a scheme to boost Trump, National Enquirer publisher American Media Inc. paid $150,000 to model and actor Karen McDougal , who appeared in Playboy magazine and claimed that she had a nine-month affair with Trump before he was elected president “in exchange for her agreement not to speak out about the alleged sexual relationship,” according to a statement of facts filed by Bragg.

Trump has also denied having a sexual relationship with McDougal.

Adam Reiss is a reporter and producer for NBC and MSNBC.

Lisa Rubin is an MSNBC legal correspondent and a former litigator.

Dareh Gregorian is a politics reporter for NBC News.