Pathological Narcissism and Depressive Symptoms in Psychiatric Outpatients: Mediating Role of Dysfunctional Attitudes

Abstract

Among adult psychiatric outpatients, narcissistic vulnerability is more strongly related to depressive symptoms than narcissistic grandiosity, and dysfunctional perfectionism represents one of the underlying mechanisms of this relationship. The implications of these findings are discussed in relation to the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria and the treatment of pathological narcissism.

Narcissistic Vulnerability and Grandiosity as Mediators Between Insecure Attachment and Future Eating Disordered Behaviors: A Prospective Analysis of Over 2,000 Freshmen

“…Existing psychiatric and social and personality psychology literature highlights the existence and supports the validity of two phenotypic variants of narcissistic dysfunction, grandiosity and vulnerability (cf. Fossati, Feeney, Pincus, Borroni, & Maffei, ; Marčinko et al., ). Narcissistic grandiosity that best captures the representation of narcissistic personality disorder is characterized by an overvalued, entitled self‐image with exhibitionistic behaviors and arrogance and reactivity to criticism.…”

“…Narcissistic grandiosity that best captures the representation of narcissistic personality disorder is characterized by an overvalued, entitled self‐image with exhibitionistic behaviors and arrogance and reactivity to criticism. Narcissistic vulnerability is characterized by a frail self‐image, self‐adequacy concerns, hypersensitivity to criticism, and withdrawal when narcissistic needs are not met (e.g., Fossati et al., ; Marčinko et al., ). The internal working models of the self and others have been implicated in the development of the phenotypic forms of narcissistic dysfunction in personality and attachment literature (e.g., Diamond & Meehan, ; Mikulincer & Shaver, ), with several scholars describing how specific insecure attachment experiences can give rise to variants of narcissism that emphasize either grandiosity or vulnerable affects and self‐states.…”

Grandiose and Vulnerable Narcissism in Borderline Personality Disorder

“…Evidence suggests that the PNI measures narcissistic traits appropriately [32-37], although it has been criticized for not sufficiently assessing grandiose narcissism [38]. However, its validity has been confirmed repeatedly with various samples [39-42]. …”

“…Further, especially vulnerable narcissism was associated with anger [44-46], impulsiveness [44], depression, and a depressive temperament. [32, 42-44, 47]. Women had slightly higher scores in total narcissism and on the vulnerable scale, while men had higher scores on the grandiose scale of the PNI [30].…”

Perfectionism, Shame, and Aggression in Depressive Patients With Narcissistic Personality Disorder

“…Narcissistic personality disorder (NPD) is known to be associated with perfectionism, shame, and aggression, and several studies have pointed to the presence and impact of these features in patients with NPD (Fjermestad-Noll et al, 2019;Kealy, Tsai, & Ogrodniczuk, 2012;Kernberg, 2009;Marčinko et al, 2014;Ogrodniczuk, Piper, Joyce, Steinberg, & Duggal, 2009;Velotti, Ellison, & Garofalo, 2014). In particular, the co-occurrence of and interaction between perfectionism, shame, and aggression can challenge self-esteem, escalate vulnerability, and contribute to susceptibility to symptoms of depression in NPD (Dawood & Pincus, 2018;Huprich, Porcerelli, Keaschuk, Binienda, & Engle, 2008;Marčinko et al, 2014;Ronningstam, 2011). Perfectionism is related to shame and aggression, especially in situations when perfectionistic standards are not possible to attain.…”