narcissism and narcissistic PD

narcissism def

stable personality trait that has:

• grandiosity

• self-love

• inflated self-views

• fragile self-esteem

normally-distributed in the population

trait narcissism self:

positivity, ‘specialness’ and uniqueness, vanity, entitlement, desire for power and esteem.

trait narcissism relationships

low levels of empathy and emotional intimacy

shallow relationships that reinforce the self aspect of narc.

narcissism regulation of self-inflated views

• seeking out opportunities for attention and admiration

• bragging

• stealing credit from others

• controlling in relationships

what does successful regulation look like for narcissism

high self-esteem, positive life satisfaction

what does unsuccessful regulation look like for narcissism

aggression, anxiety, and depression

how does narcissism vary in a population

normally

there may be some benefits to semi-elevated narcissism

risk of interpersonal conflict when excessively elevated

narcissism (trait) FFM

higher extraversion - need for social validation

higher openness - wants to present as open to ideas - saying your closed mindedness makes you look bad

lower agreeableness

common themes across narcissistic forms

• self-centered

• manipulative

• fragile self-esteem

• difficulties with empathy

• impulsivity

grandiose narcissism def

‘classical’ narcissism, DSM based on this type.

• dominance, self assured, exhibitionist, entitled, aggressive and hostile when challenged, immodest

outside appearance for grandiose narc.

confident and dominant

attention-seeking

emotional expression grandiose narcissism

emotionally detached - superficial

aggressive - when challenged

interpersonal expressions grandiose narc.

exploitative - using others for own need

superficial

self-esteem grandiose narc.

overtly high - on outside, but might not be true

grandiose narc. etiology (cause)

parental overvaluation = constantly told that you are the best then you start to believe it.

what are the motivations for grandiose narcissism

primarily for sensation and thrill seeking

what type of personalities is grandiose narc. linked to

antisocial personalities - going against society and psychopathy - manipulating others

vulnerable narc. def

woe is me, my problems are unique and no one gets me.

• negative emotionality

• interpersonal coldness

• hostile in reaction to negative emotions

• need for recognition

• entitled

• egocentric

strongly associated with distrust of others

outside appearance for vulnerable narc.

insecure and defensive

shy and anxious

hypersensitive to criticism

emotional expression vulnerable narc

emotionally reactive

passive-aggressive

interpersonal expressions vulnerable narc.

fear rejection

overly attached or avoidant

self-esteem vulnerable narc

covertly low, may lie but it is really low

vulnerable narc etiology

parental coldness - childhood neglect and potential abuse

motivations for impulsivity in vulnerable narc

difficulties with impulse control overall

what type of personalities is vulnerable narc linked to

borderline personalities - difficulties regulating emotions, especially in the presence of rejection

shared degrees of narc

entitlement and antagonistic interpersonal stance

antagonism in grandiose narc

associated with immodesty, deceitfulness and refusal to comply with authority figures

antagonism in vulnerable narc

associated with distrust, hostility driven by increased negative effect, and problematic attachment styles

what are benefits to semi-elevated narcissism

confidence can be viewed positively by others when selecting leadership roles, particularly grandiose narcissism

careers in science & mathematics, business, politics

consequences of low narcissism

poor self-esteem, unclear sense of self

DSM def of Narc PD

extreme and pervasive pattern of grandiosity

exessive need for admiration

lack of empathy

FFM narcissism PD

low agreeableness

pathological traits of Narc PD

grandiosity

attention seeking

prevalence of NPD

0% - 6.2%

NPD heritabiltiy

NPD likely due to more environmental factors than genetics

may be associated with biological predispositions to negative affect

which psychiatric disorders are comorbid with NPD

mood disorders, anxiety disorders, substance use disorders

which personality disorders are comorbid with NPD

Schizotypal, paranoid, borderline,

pretty much all of them but mainly those

problems with categorical NPD

primary focus on externalizing aspects of disorder

• ignores vulnerability to self-esteem as core diagnostic criteria

two people can have NPD with different presentations

• malignant narc vs. high functioning narc

DSM mainly measures grandiose narcissism

AMPD NPD elevated pathological traits (criterion B)

must have both:

grandiosity

• feelings of entitlement, either overt or cover; self-centeredness; firmly holding to the belief that one is better than others

attention seeking

• excessive attempts to attract and be the focus of the attention of others; admiration seeking

AMPD NPD criterion A: self-functioning impairments: identity

• excessive looking to others for self-definition and self-esteem regulation

• exaggerated self-appraisal inflated or deflated, or flipping between extremes

• emotional dysregulation

AMPD NPD criterion A: self-functioning impairments: self-direction

• goal setting based on gaining approval from others

• personal standard unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement

  • often unaware of own motivations

AMPD NPD criterion A: self-functioning impairments: empathy

• impaired ability to recognize or identity with the feelings and needs of others

• excessively attuned to reaction of others, but only if its relevant to self

• over- or underestimation of own effect on others

AMPD NPD criterion A: self-functioning impairments: intimacy

• relationships are superficial and exist to for self-esteem regulation

• mutuality constrained by little genuine interest in other’s experiences and predominance of need for personal gain

Why is AMPD good for diagnosis of NPD

allows for NPD diagnosis with emphasis on subtype like malignant, vulnerable, etc.

why was NPD originally excluded from AMPD

• better classified as pathological traits (purely dimensional)

• redundant category given comorbidity with other disorders

• overemphasis on external behaviors

• history of underdiagnosis and poor clinical utility

pros to NPD in AMPD

criterion A (personality functioning) provides more detail about the process of narcissism

allows for dimensionality to describe severity of personality functioning

defines the role of motivation and emotions in the impairments and fluctuations of empathy