CLINICAL CORRELATES OF VULNERABLE AND GRANDIOSE NARCISSISM
A PERSONALITY PERSPECTIVE
Scott Barry Kaufman, PhD, Brandon Weiss, MA, Joshua D. Miller,
PhD, and W. Keith Campbell, PhD
There is broad consensus that there are at least two different dimensions
of narcissism: vulnerable and grandiose. In this study, the authors use a
new trifurcated, three-factor model of narcissism to examine relations
between aspects of narcissism and an array of clinically relevant criteria
related to psychopathology, the self, authenticity, and well-being. Neurotic
and antagonistic aspects of narcissism emerged as the most clinically
relevant dimensions of narcissism, bearing relations with outcomes relating
to interpersonal guilt, insecure attachment styles, cognitive distortions,
maladaptive defense mechanisms, experiential avoidance, impostor
syndrome, weak sense of self, inauthenticity, low self-esteem, and reduced
psychological well-being. Grandiose narcissism was not correlated with
most forms of psychopathology and was even positively associated with life satisfaction. Nevertheless, a surprising link was found between grandiose
narcissism and multiple indicators of inauthenticity. Implications for the
appropriate conceptualization, assessment, and treatment of pathological
narcissism are discussed.
Keywords: three-factor model, narcissism, trifurcated model, antagonism,
vulnerable, grandiose, clinical, psychopathology, authenticity
There is broad consensus that there are at least two different dimensions
of narcissism that have been discussed using different labels depending on the research tradition (e.g., Dickinson & Pincus, 2003; Fossati et al, 2005; Kernberg, 1975, 1986; Kohut, 1966, 1971, 1977; Miller & Campbell, 2008; Pincus & Lukowitsky, 2010; Reich, 1949, 1960; Russ, Shedler, Bradley, & Westen, 2008; Wink, 1991). In general, grandiose narcissism is associated with traits such as exhibitionism, immodesty, interpersonal dominance, selfabsorption, callousness, manipulativeness, and a need for acclaim from others. In contrast, vulnerable narcissism is associated with psychological distress,
--------------
From Positive Psychology Center, University of Pennsylvania, Philadelphia, Pennsylvania (S. B. K.); and University of Georgia, Athens, Georgia (B. W., J. D. M., W. K. C.). The authors would like to thank Elizabeth Hyde for her assistance setting up the experiments and preparing the data for analysis.
Brandon Weiss and Scott Barry Kaufman contributed equally to the preparation of this article.
Address correspondence to Scott Barry Kaufman, 3701 Market St., Suite 217, Positive Psychology Center,
University of Pennsylvania, Philadelphia, PA 19003. E-mail: scott@scottbarrykaufman.com
---------------
anxiety, depression, negative emotions, withdrawal, hypersensitivity to criticism, and feelings of inferiority paired with an egocentric, entitled, and distrustful approach to interpersonal relations.
Over time, this two-dimensional model of narcissism has revealed important clinical implications because the descriptions of vulnerable and grandiose narcissism differ substantially, as do their nomological networks (Cain, Pincus,& Ansell, 2008; Hyatt et al., in press; Miller et al., 2011; Wink, 1991). Vulnerable narcissism has been linked to features characteristic of internalizing disorders, including anxiety, depression, paranoia, schizotypy, distrust, hostility, low self-esteem, and extreme sensitivity to criticism and rejection, with a similar nomological network to both neuroticism and borderline personality disorders (PD) (e.g., Ellison, Levy, Cain, Ansell, & Pincus, 2013; Miller et al., 2010, 2011, 2018; Pincus, Cain, & Wright, 2014). A robust empirical literature indicates that negative emotionality (or neuroticism), in addition to driving these relations with vulnerable narcissism (Miller et al., 2018), may represent a common factor underlying all internalizing disorders, and may even underlie a general factor of psychopathology (e.g., Lahey, 2009; Tackett, 2013). This would explain why neuroticism is related to the vast majority of “Axis I and II” disorders (e.g., Kotov et al., 2010; Samuel & Widiger, 2008). In contrast, grandiose narcissism is a more distinct construct with specific links to externalizing
disorders, including proactive verbal and physical aggression, drive for
dominance, and histrionic behaviors (e.g., Miller et al., 2011; Miller, Lynam,
Hyatt, & Campbell, 2017).
Despite these relations, experts agree that features of vulnerable narcissism are underrepresented in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5; American Psychiatric Association [APA], 2013) criteria for narcissism (Miller, Lynam, & Campbell, 2016; Russ et al., 2008; Weiss & Miller, in press). Factor analyses of narcissistic personality disorder (NPD) symptoms suggest that the DSM-IV NPD criteria are either primarily or entirely consistent with grandiose narcissism (Fossati et al., 2005; Miller, Hoffman, Campbell, & Pilkonis, 2008; Weiss & Miller, in press). Furthermore, the alternative DSM-5 model of NPD contained in Section III for “emerging models and measures” primarily involves grandiose elements of narcissism (Criterion B: grandiosity, attention seeking), although personality dysfunction required in Criterion A includes some vulnerable features (e.g., “excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal inflated or deflated, or vacillating between extremes; emotional regulation mirrors fluctuations in self-esteem” [APA, 2013, p. 767]).
In addition, vulnerable narcissism remains diminutive within more recent
dimensional models of psychopathology as well. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a dimensional alternative to the DSM that groups related symptoms together, and groups co-occurring syndromes into spectra (Kotov et al., 2017). Within the HiTOP model, narcissism is included under the umbrella “antagonistic externalizing” and is grouped together with histrionic PD, paranoid PD, and borderline PD. Nevertheless, developers of the HiTOP model are continuing to investigate the location of NPD within the structure of common mental disorders. In line with NPD’s heterogeneous composition of extraverted, antagonistic, and neurotic traits (e.g., Samuel & Widiger, 2008), empirical evidence is mixed with respect to where NPD is located within the structure of common mental disorders, with some findings suggesting that NPD may best be characterized as an externalizing disorder (e.g., Kendler et al., 2011), others failing to find support for significant relations (e.g., Røysamb et al., 2011), and still others indicating that NPD is a distress disorder with stronger relations to internalizing, despite nontrivial relations to externalizing, and uniquely high disorder-specific variance that is
not easily accounted for (Eaton et al., 2017). Ultimately, the manner in which narcissism relates to other disorders, even when measuring the same putative form of narcissism, can vary substantially depending on the assessment used (e.g., Miller et al., 2014). Investigations into the location of grandiose and vulnerable narcissism within the structure of common mental disorders may help clarify these issues.
EXAMINING CLINICAL RELATIONS WITH NARCISSISM USING THE TRIFURCATED MODEL
Over the past 15 years, there has been a proliferation of self-report measures that capture the narcissism construct more comprehensively in that they assess both grandiose and vulnerable components of narcissism. One notable scale is the Five-Factor Narcissism Inventory (FFNI), which was developed to assess traits associated with NPD, as well as grandiose and vulnerable narcissism from a basic personality perspective (Miller et al., 2013). This model has been expanded in recent years by a personality trait–based approach that facilitates understanding the central versus peripheral features of narcissism (Miller, Lynam, et al., 2017). A striking convergence of data suggests that there are three dimensions of personality that more parsimoniously characterize the underlying structure of narcissism: agentic extraversion, disagreeableness, and neuroticism (Miller, Lynam, et al., 2017; cf. Krizan & Herlache, 2018). Although the FFNI was created from the perspective of the Five-Factor Model
(FFM; Costa & McCrae, 1992), and thus its three dimensions map onto
corresponding domains of FFM personality, the FFNI items were written to
assess more maladaptive content directly relevant to narcissism (Glover, Miller,Lynam, Crego, & Widiger, 2012).
According to the trifurcated model, the core of narcissism that binds
both grandiose and vulnerable narcissism together is best characterized as
interpersonal antagonism, involving the hostile and manipulative aspects of
disagreeableness, such as entitlement, manipulativeness, callousness, and reactive anger (Miller, Lynam, et al., 2017). There are nuanced differences between the two narcissism dimensions even at this level, as grandiose narcissism is more strongly related to immodesty and vulnerable narcissism is more strongly related to distrust (Miller, Lynam, et al., 2017), which may suggest different motivations for interpersonally antagonistic behaviors (e.g., Miller et al., 2010). The trifurcated model suggests that neuroticism and agentic extraversion are features that may work as “diagnostic specifiers” that provide additional important information above and beyond the core of antagonism. As Miller, Lynam, et al. (2017) noted, “neuroticism and extraversion serve to distinguish or drive apart grandiose and vulnerable narcissism” (p. 296). Specifically, neuroticism
(i.e., shame, self-consciousness, unstable self-esteem) is related to the more vulnerable aspects of narcissism, whereas agentic extraversion (i.e., acclaim seeking, authoritativeness, exhibitionism) is related to the more grandiose aspects of narcissism. In simple trait terms, the grandiose narcissistic individual may be a “disagreeable extravert” (Paulhus, 2001), whereas the vulnerable narcissistic individual is “neurotically disagreeable” (our term). Ultimately, the field benefited greatly in the recognition of these two narcissism dimensions—grandiose and vulnerable—in that it explained the heterogeneity in presentations and correlates associated with narcissism (and various narcissism measures). However, it may be time for another progression in which the grandiose versus vulnerable bifurcation is augmented with a three-factor model that provides even greater flexibility by allowing researchers to understand more unidimensional components of narcissism and how they play a role in individuals’ functioning. Examining the clinical correlates of narcissism using the trifurcated model of narcissism affords researchers the opportunity to granularly examine which aspects of narcissism bear the most meaningful associations with and underlie maladaptive functioning.
We should note that the trifurcated model is not merely another model with its own factor structure (e.g., the subscale structure of other narcissism scales), but rather it represents a new evolution in measurement that cuts narcissism more cleanly at the joints of its psychological components (Krizan & Herlache, 2018; Miller, Lynam, & Campbell, 2016). Examining the nomological network of narcissism using the trifurcated model thus enables researchers to observe narcissism’s nomological network in higher resolution than was possible with the two-factor model where certain contributing components (e.g., Antagonism) were obscured. Using the trifurcated model may also yield clearer insight into appropriate treatment targets within NPD. For example, the trifurcated model is able to elucidate Antagonism’s unique relations to maladaptive functioning and could thus point to Antagonism as a promising psychotherapeutic target as well as lead to the development of more targeted and efficacious therapies.
Dr. Jeffrey Levine a Hartford Therapist Licensed Psychologist with over 40 years of clinical experience. He specializes in treating adults in individual psychotherapy, with expertise in trauma focused hypnosis, energy transformational healing and Internal Family Systems.
Scott Barry Kaufman, PhD, Brandon Weiss, MA, Joshua D. Miller,
PhD, and W. Keith Campbell, PhD
There is broad consensus that there are at least two different dimensions
of narcissism: vulnerable and grandiose. In this study, the authors use a
new trifurcated, three-factor model of narcissism to examine relations
between aspects of narcissism and an array of clinically relevant criteria
related to psychopathology, the self, authenticity, and well-being. Neurotic
and antagonistic aspects of narcissism emerged as the most clinically
relevant dimensions of narcissism, bearing relations with outcomes relating
to interpersonal guilt, insecure attachment styles, cognitive distortions,
maladaptive defense mechanisms, experiential avoidance, impostor
syndrome, weak sense of self, inauthenticity, low self-esteem, and reduced
psychological well-being. Grandiose narcissism was not correlated with
most forms of psychopathology and was even positively associated with life satisfaction. Nevertheless, a surprising link was found between grandiose
narcissism and multiple indicators of inauthenticity. Implications for the
appropriate conceptualization, assessment, and treatment of pathological
narcissism are discussed.
Keywords: three-factor model, narcissism, trifurcated model, antagonism,
vulnerable, grandiose, clinical, psychopathology, authenticity
There is broad consensus that there are at least two different dimensions
of narcissism that have been discussed using different labels depending on the research tradition (e.g., Dickinson & Pincus, 2003; Fossati et al, 2005; Kernberg, 1975, 1986; Kohut, 1966, 1971, 1977; Miller & Campbell, 2008; Pincus & Lukowitsky, 2010; Reich, 1949, 1960; Russ, Shedler, Bradley, & Westen, 2008; Wink, 1991). In general, grandiose narcissism is associated with traits such as exhibitionism, immodesty, interpersonal dominance, selfabsorption, callousness, manipulativeness, and a need for acclaim from others. In contrast, vulnerable narcissism is associated with psychological distress,
--------------
From Positive Psychology Center, University of Pennsylvania, Philadelphia, Pennsylvania (S. B. K.); and University of Georgia, Athens, Georgia (B. W., J. D. M., W. K. C.). The authors would like to thank Elizabeth Hyde for her assistance setting up the experiments and preparing the data for analysis.
Brandon Weiss and Scott Barry Kaufman contributed equally to the preparation of this article.
Address correspondence to Scott Barry Kaufman, 3701 Market St., Suite 217, Positive Psychology Center,
University of Pennsylvania, Philadelphia, PA 19003. E-mail: scott@scottbarrykaufman.com
---------------
anxiety, depression, negative emotions, withdrawal, hypersensitivity to criticism, and feelings of inferiority paired with an egocentric, entitled, and distrustful approach to interpersonal relations.
Over time, this two-dimensional model of narcissism has revealed important clinical implications because the descriptions of vulnerable and grandiose narcissism differ substantially, as do their nomological networks (Cain, Pincus,& Ansell, 2008; Hyatt et al., in press; Miller et al., 2011; Wink, 1991). Vulnerable narcissism has been linked to features characteristic of internalizing disorders, including anxiety, depression, paranoia, schizotypy, distrust, hostility, low self-esteem, and extreme sensitivity to criticism and rejection, with a similar nomological network to both neuroticism and borderline personality disorders (PD) (e.g., Ellison, Levy, Cain, Ansell, & Pincus, 2013; Miller et al., 2010, 2011, 2018; Pincus, Cain, & Wright, 2014). A robust empirical literature indicates that negative emotionality (or neuroticism), in addition to driving these relations with vulnerable narcissism (Miller et al., 2018), may represent a common factor underlying all internalizing disorders, and may even underlie a general factor of psychopathology (e.g., Lahey, 2009; Tackett, 2013). This would explain why neuroticism is related to the vast majority of “Axis I and II” disorders (e.g., Kotov et al., 2010; Samuel & Widiger, 2008). In contrast, grandiose narcissism is a more distinct construct with specific links to externalizing
disorders, including proactive verbal and physical aggression, drive for
dominance, and histrionic behaviors (e.g., Miller et al., 2011; Miller, Lynam,
Hyatt, & Campbell, 2017).
Despite these relations, experts agree that features of vulnerable narcissism are underrepresented in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5; American Psychiatric Association [APA], 2013) criteria for narcissism (Miller, Lynam, & Campbell, 2016; Russ et al., 2008; Weiss & Miller, in press). Factor analyses of narcissistic personality disorder (NPD) symptoms suggest that the DSM-IV NPD criteria are either primarily or entirely consistent with grandiose narcissism (Fossati et al., 2005; Miller, Hoffman, Campbell, & Pilkonis, 2008; Weiss & Miller, in press). Furthermore, the alternative DSM-5 model of NPD contained in Section III for “emerging models and measures” primarily involves grandiose elements of narcissism (Criterion B: grandiosity, attention seeking), although personality dysfunction required in Criterion A includes some vulnerable features (e.g., “excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal inflated or deflated, or vacillating between extremes; emotional regulation mirrors fluctuations in self-esteem” [APA, 2013, p. 767]).
In addition, vulnerable narcissism remains diminutive within more recent
dimensional models of psychopathology as well. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a dimensional alternative to the DSM that groups related symptoms together, and groups co-occurring syndromes into spectra (Kotov et al., 2017). Within the HiTOP model, narcissism is included under the umbrella “antagonistic externalizing” and is grouped together with histrionic PD, paranoid PD, and borderline PD. Nevertheless, developers of the HiTOP model are continuing to investigate the location of NPD within the structure of common mental disorders. In line with NPD’s heterogeneous composition of extraverted, antagonistic, and neurotic traits (e.g., Samuel & Widiger, 2008), empirical evidence is mixed with respect to where NPD is located within the structure of common mental disorders, with some findings suggesting that NPD may best be characterized as an externalizing disorder (e.g., Kendler et al., 2011), others failing to find support for significant relations (e.g., Røysamb et al., 2011), and still others indicating that NPD is a distress disorder with stronger relations to internalizing, despite nontrivial relations to externalizing, and uniquely high disorder-specific variance that is
not easily accounted for (Eaton et al., 2017). Ultimately, the manner in which narcissism relates to other disorders, even when measuring the same putative form of narcissism, can vary substantially depending on the assessment used (e.g., Miller et al., 2014). Investigations into the location of grandiose and vulnerable narcissism within the structure of common mental disorders may help clarify these issues.
EXAMINING CLINICAL RELATIONS WITH NARCISSISM USING THE TRIFURCATED MODEL
Over the past 15 years, there has been a proliferation of self-report measures that capture the narcissism construct more comprehensively in that they assess both grandiose and vulnerable components of narcissism. One notable scale is the Five-Factor Narcissism Inventory (FFNI), which was developed to assess traits associated with NPD, as well as grandiose and vulnerable narcissism from a basic personality perspective (Miller et al., 2013). This model has been expanded in recent years by a personality trait–based approach that facilitates understanding the central versus peripheral features of narcissism (Miller, Lynam, et al., 2017). A striking convergence of data suggests that there are three dimensions of personality that more parsimoniously characterize the underlying structure of narcissism: agentic extraversion, disagreeableness, and neuroticism (Miller, Lynam, et al., 2017; cf. Krizan & Herlache, 2018). Although the FFNI was created from the perspective of the Five-Factor Model
(FFM; Costa & McCrae, 1992), and thus its three dimensions map onto
corresponding domains of FFM personality, the FFNI items were written to
assess more maladaptive content directly relevant to narcissism (Glover, Miller,Lynam, Crego, & Widiger, 2012).
According to the trifurcated model, the core of narcissism that binds
both grandiose and vulnerable narcissism together is best characterized as
interpersonal antagonism, involving the hostile and manipulative aspects of
disagreeableness, such as entitlement, manipulativeness, callousness, and reactive anger (Miller, Lynam, et al., 2017). There are nuanced differences between the two narcissism dimensions even at this level, as grandiose narcissism is more strongly related to immodesty and vulnerable narcissism is more strongly related to distrust (Miller, Lynam, et al., 2017), which may suggest different motivations for interpersonally antagonistic behaviors (e.g., Miller et al., 2010). The trifurcated model suggests that neuroticism and agentic extraversion are features that may work as “diagnostic specifiers” that provide additional important information above and beyond the core of antagonism. As Miller, Lynam, et al. (2017) noted, “neuroticism and extraversion serve to distinguish or drive apart grandiose and vulnerable narcissism” (p. 296). Specifically, neuroticism
(i.e., shame, self-consciousness, unstable self-esteem) is related to the more vulnerable aspects of narcissism, whereas agentic extraversion (i.e., acclaim seeking, authoritativeness, exhibitionism) is related to the more grandiose aspects of narcissism. In simple trait terms, the grandiose narcissistic individual may be a “disagreeable extravert” (Paulhus, 2001), whereas the vulnerable narcissistic individual is “neurotically disagreeable” (our term). Ultimately, the field benefited greatly in the recognition of these two narcissism dimensions—grandiose and vulnerable—in that it explained the heterogeneity in presentations and correlates associated with narcissism (and various narcissism measures). However, it may be time for another progression in which the grandiose versus vulnerable bifurcation is augmented with a three-factor model that provides even greater flexibility by allowing researchers to understand more unidimensional components of narcissism and how they play a role in individuals’ functioning. Examining the clinical correlates of narcissism using the trifurcated model of narcissism affords researchers the opportunity to granularly examine which aspects of narcissism bear the most meaningful associations with and underlie maladaptive functioning.
We should note that the trifurcated model is not merely another model with its own factor structure (e.g., the subscale structure of other narcissism scales), but rather it represents a new evolution in measurement that cuts narcissism more cleanly at the joints of its psychological components (Krizan & Herlache, 2018; Miller, Lynam, & Campbell, 2016). Examining the nomological network of narcissism using the trifurcated model thus enables researchers to observe narcissism’s nomological network in higher resolution than was possible with the two-factor model where certain contributing components (e.g., Antagonism) were obscured. Using the trifurcated model may also yield clearer insight into appropriate treatment targets within NPD. For example, the trifurcated model is able to elucidate Antagonism’s unique relations to maladaptive functioning and could thus point to Antagonism as a promising psychotherapeutic target as well as lead to the development of more targeted and efficacious therapies.
Dr. Jeffrey Levine a Hartford Therapist Licensed Psychologist with over 40 years of clinical experience. He specializes in treating adults in individual psychotherapy, with expertise in trauma focused hypnosis, energy transformational healing and Internal Family Systems.
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