Can Patients With Narcissistic Personality Disorder Change? A Case Series.

ABSTRACT: The study was set out to establish the potential for psychotherapy to effect improvements in patients with narcissistic personality disorder (NPD). Eight patients with NPD who improved in treatment were identified. Consensus clinician/investigator diagnostic scores from before and after the psychotherapies were retroactively established on the Diagnostic Interview for Narcissism (DIN) and the Diagnostic Statistic Manual for Psychiatric Disorders, 5th Edition (DSM-5) Personality Disorder Section II criteria. Psychosocial functioning (work or school, romantic relationships) before and after the psychotherapies was retroactively evaluated as well. At the completion of the therapies after 2.5 to 5 years, all patients had improved, no longer met DIN or DSM-5 criteria for NPD, and showed better psychosocial functioning. Symptomatic improvements were associated with large effect sizes. In conclusion, changes in NPD can occur in treatment after 2.5 to 5 years. Future research should identify patient characteristics, interventions, and common processes in such improved cases that could help with development of treatments.

A Deviance Regulation Theory Intervention Affects the Association Between Narcissistic Traits and Alcohol Harm Reduction Strategies in College Students.

Background: College students continue to report problematic alcohol use. To mitigate adverse outcomes, recent studies have employed harm reduction strategies known as Protective Behavioral Strategies (PBS). Deviance Regulation Theory (DRT), an impression management intervention, has been used to promote the use of PBS. DRT relies on impression management to modify behavior. This may be especially important for individuals with higher levels of trait narcissism. Method: College student drinkers (n = 132) were randomly assigned to receive a positive message about PBS users, a negative message about non-PBS users, or control. Participants reported on current PBS use norms, daily alcohol use, PBS use, and any alcohol-related problems experienced during the previous week for the next 10 weeks. Results: Data were analyzed using multilevel regression to examine PBS use across time by condition. When PBS norms were low, narcissism was strongly associated with lower rates of PBS use in the control group. If individuals received a positive or negative message, the association between narcissism and PBS use was diminished, among individuals with low PBS norms. There were no significant differences at mean or high levels of norms, indicating the messaging was only important for the highest risk group (i.e., those with low PBS norms). Discussion: The results of this study suggest that message framing may be effective at reducing the robust negative association between narcissism and PBS use for individuals with low PBS norms. Positive messages about individuals that use PBS may be one approach to mitigating problematic alcohol consumption in this at-risk group.

Social anxiety and social networking service addiction proneness among university students: A moderated mediation model of narcissism and gender.

This study aims to investigate the mediation effect of narcissism and the mediation effect moderated by gender in the effect of social anxiety on university students' SNS addiction. In this cross-sectional survey, university students, aged 19 to 29 were selected from two provinces in South Korea. The sample size was calculated using G*power 3.1., and a sample of 170 university students was used in the final analysis. To perform the analysis, descriptive statistics; independent t-test, one-way ANOVA, and Pearson's correlation were used. The data collected was statistically analyzed using SPSS Program 23.0 and SPSS PROCESS macro (version 4.0). The moderated mediation effect was significant in both male and female groups. The mediation effect of narcissism on the relationship between social anxiety and SNS addiction proneness was stronger in the female group than in the male group. The findings have the potential to provide substantial basic data for developing health promotion and education programs to reduce university students' social anxiety, narcissism, and SNS addiction.

Treating Narcissistic Disorders in General Psychiatry: Practical Application of Transference-Focused Psychotherapy Principles.

Patients with primary or co-occurring narcissistic disorders are seen routinely in general psychiatry settings. Contemporary trends in training and practice have impacted psychiatrists' skills and confidence in identifying and treating these disorders, which can range from relatively benign to high-acuity presentations. The goal of this article is to introduce key principles derived from transference-focused psychotherapy (TFP) for use by clinicians in general practice in their work with patients with narcissistic disorders, even when those clinicians do not routinely provide individual psychotherapy. Practical application of TFP principles in work with patients with narcissistic disorders in general psychiatry are proposed, including in diagnostic evaluation, family engagement, prescribing, and safety assessment and risk management calculus. Many psychiatrists whose practices are focused primarily on psychopharmacology, or a "medical model," may not appreciate fully the impact of pathological narcissism in their work. Clinicians who may benefit from familiarity with TFP principles in work with patients with narcissistic disorders include the approximately one-half of U.S. psychiatrists who do not offer psychotherapy in their practice.

Dispositional Empathy Among Psychotherapists: A Latent Profile Analysis.

OBJECTIVE: This study examined therapists' dispositional empathy profiles and how they differ based on professional and personal characteristics. METHOD: A total of 376 clinicians was recruited for this study. Dispositional empathy was assessed with the Interpersonal Reactivity Index (IRI). Profiles were generated using latent profile analysis. Predictors of profiles were assessed with multiple self-report questionnaires measuring demographic and professional characteristics, romantic attachment styles, five-factor personality traits and vulnerable narcissism. RESULTS: A four-profile solution was retained with the following proportions: rational empathic (20%), disengaged/detached (10%), empathic immersion (35%) and insecure/self-absorbed (35%). Overall, few relationships were found regarding demographic and professional characteristics. In contrast, significant relationships were found between profile membership and personal characteristics, including avoidant and anxious attachment, agreeableness, conscientiousness, neuroticism, intellect/imagination and vulnerable narcissism. CONCLUSION: The findings show that differences in therapists' empathic dispositions are linked to personality dimensions. Implications for psychotherapy research, practice and training are discussed.

Linking grandiose and vulnerable narcissism to managerial work performance, through the lens of core personality traits and social desirability.

While grandiose narcissism is well-studied, vulnerable narcissism remains largely unexplored in the workplace context. Our study aimed to compare grandiose and vulnerable narcissism among managers and people from the general population. Within the managerial sample, our objective was to examine how these traits diverge concerning core personality traits and socially desirable responses. Furthermore, we endeavored to explore their associations with individual managerial performance, encompassing task performance, contextual performance, and counterproductive work behavior (CWB). Involving a pool of managerial participants (N = 344), we found that compared to the general population, managers exhibited higher levels of grandiose narcissism and lower levels of vulnerable narcissism. While both narcissistic variants had a minimal correlation (r = .02) with each other, they differentially predicted work performance. Notably, grandiose narcissism did not significantly predict any work performance dimension, whereas vulnerable narcissism, along with neuroticism, predicted higher CWB and lower task performance. Conscientiousness emerged as the strongest predictor of task performance. This study suggests that organizations might not benefit from managers with vulnerable narcissism. Understanding these distinct narcissistic variants offers insights into their impacts on managerial performance in work settings.

Grandiose narcissism associates with higher cognitive performance under stress through more efficient attention distribution: An eye-tracking study.

Narcissism is a part of the Dark Triad that consists also of the traits of Machiavellianism and psychopathy. Two main types of narcissism exist: grandiose and vulnerable narcissism. Being a Dark Triad trait, narcissism is typically associated with negative outcomes. However, recent research suggests that at least the grandiose type may be linked (directly or indirectly) to positive outcomes including lower levels of psychopathology, higher school grades in adolescents, deeper and more strategic learning in university students and higher cognitive performance in experimental settings. The current pre-registered, quasi-experimental study implemented eye-tracking to assess whether grandiose narcissism indirectly predicts cognitive performance through wider distribution of attention on the Raven's Progressive Matrices task. Fifty-four adults completed measures of the Dark Triad, self-esteem and psychopathology. Eight months to one year later, participants completed the Raven's, while their eye-movements were monitored during high stress conditions. When controlling for previous levels of psychopathology, grandiose narcissism predicted higher Raven's scores indirectly, through increased variability in the number of fixations across trials. These findings suggest that grandiose narcissism predicts higher cognitive performance, at least in experimental settings, and call for further research to understand the implications of this seemingly dark trait for performance across various settings.

Initial tweet valence, abuse volume, and observer Dark Tetrad characteristics influence perceptions of female celebrity abuse on Twitter.

Research into relationships between victim-generated content, abuse received, and observer characteristics when considering Twitter abuse has been limited to male victims. We evaluated participant perceptions of female celebrity victims and abuse received on Twitter. We used a 3 (Initial Tweet Valence; negative, neutral, positive) × 2 (Abuse Volume; low, high) repeated measures design and online survey method. Participants were shown tweets generated by six female celebrities, counterbalanced such that each participant saw each celebrity in one Valence-Volume condition. Stimuli were presented across six 'lists' such that celebrity 'victims' could be rotated across Valence-Volume pairings. Participants rated-per target stimulus-the level of blame attributable to the victim and the perceived severity of the incident. Furthermore, participants were asked to complete a Dark Tetrad scale-measuring their Machiavellianism, Narcissism, Psychopathy, and Sadism. Analyses determined that victim-blaming was influenced by victim Initial Tweet Valence (greater victim-blaming associated with more-negative content) and observer Machiavellianism. Perceived severity was influenced by victim Initial Tweet Valence, Volume of Abuse received, and observer Machiavellianism. Results were consistent with previous research involving male celebrity victims. Further research is needed to understand the contributions of participants' hostile and benevolent sexism, as well as the role of victim attractiveness.

Exploring grandiose narcissism among surgeons: a comparative analysis.

The concept of narcissism encompasses various personality traits, including cognitive, emotional and behavioural characteristics, which often lead to difficulties in maintaining a healthy self-esteem. This study examines the prevalence of narcissism traits (Admiration and Rivalry) in the surgical profession and their association with age, gender and professional experience. A total of 1390 participants (408 women, 982 men) took part in an online survey. The results show that female participants have significantly lower levels of rivalry than male colleagues. Additionally, age was found to be inversely correlated with both facets of narcissism, demonstrating that levels of narcissism decrease as age increases. Participants who are still in education tend to show higher levels of both facets. These results improve our understanding of personality traits in surgery and provide valuable insights for researchers and practitioners.

Narcissistic personality disorder in the ICD-11: Severity and trait profiles of grandiosity and vulnerability.

Modern diagnostic and classification frameworks such as the ICD-11 and DSM-5-AMPD have adopted a dimensional approach to diagnosing personality disorder using a dual "severity" and "trait" model. As narcissistic personality has historically struggled to be adequately captured in dominant diagnostic systems, this study investigated the utility of the new ICD-11 framework in capturing diverse narcissistic expressions. Participants were mental health clinicians (N = 180, 67% female, age = 38.9), who completed ratings of ICD-11 personality severity, trait domains and a clinical reflection for two hypothetical case vignettes reflecting either prototypical "grandiose" or "vulnerable" narcissism. The majority of clinicians (82%) endorsed a diagnosis of personality disorder for both grandiose and vulnerable vignettes. Discriminant elements of personality impairment included rigid, unrealistically positive self-view, low empathy and high conflict with others for grandiosity, and incoherent identity, low self-esteem and hypervigilant, avoidant relations with others for vulnerability. Regarding trait profile, grandiose narcissism was predominately dissocial whereas vulnerable narcissism was primarily associated with negative affectivity and detachment. Qualitative responses highlight distinct clinical themes for each presentation. These findings suggest that clinicians using the ICD-11 framework are able to identify common core elements of personality dysfunction in grandiose and vulnerable narcissism while also recognizing their distinctive differences.

Dark Tetrad personality traits, paraphilic interests, and the role of impulsivity: an EEG-study using a Go/No-Go paradigm.

Maladaptive personality traits, such as 'dark personalities' are found to result in a diverse set of negative outcomes, including paraphilic interests and associated (illegal) behaviors. It is however unclear how these are exactly related, and if related, if then only those individuals higher on dark personality traits and higher impulsivity engage in paraphilic behaviors. In the current study, 50 participants were recruited to investigate the relationship between Dark Tetrad personality traits (i.e., narcissism, psychopathy, Machiavellianism and everyday sadism), paraphilic interests (arousal and behavior) and the moderating role of impulsivity. Personality and paraphilic interests were investigated through self-report questionnaires. Impulsivity was measured both through self-reported dysfunctional impulsivity and the P3 event related potential using electroencephalography during the Go/No-Go task (i.e. response inhibition). The results showed that there was a positive association between psychopathy, sadism and paraphilic interests. Whereas everyday sadism was associated with paraphilic (self-reported) arousal, psychopathy was associated with paraphilic behavior. Although P3 amplitude was not associated with paraphilic interests, self-reported dysfunctional impulsivity was associated with paraphilic behavior specifically. However, there was no moderating role of dysfunctional impulsivity and response inhibition (P3) in the relationship between psychopathy and paraphilic behavior. Findings indicate that the relation between specific dark personalities and paraphilic interests may be more complex than initially thought. Nevertheless, risk assessment and intervention approaches for paraphilia and related behavior both may benefit from incorporating Dark Tetrad and impulsivity measurements.

In the mind of Narcissus: The mediating role of emotional regulation in the emergence of distorted cognitions.

INTRODUCTION: Currently narcissism is considered one of the most widespread phenomenon. As a consequence, its different types (grandiose and vulnerable narcissism) have been investigated from several different perspectives. The present research attempts to explore the differences between the two types of narcissism and their links with different cognitive components that are connected to these personality traits. The primary aim of our study is to investigate the possible connections among maladaptive schemas (entitlement, vulnerability, emotional deprivation) and cognitive evaluation systems (self-esteem, systemizing-empathizing) and narcissism. METHODS: We applied both correlation and path analyses to explore the hypothesized associations. RESULTS: The results show that early maladaptive schemas are strongly associated with narcissism and the empathizing system. The different subtypes of narcissism have different connections with self-esteem. CONCLUSION: Our results show that the two types of narcissism have different manifestations and connections with the early maladaptive schemas, Emphatizing Quotient, and self-esteem. Our empirical results serve as important and empirically supported inputs to counseling and clinical practice.

Narcissus reflected: Grey and white matter features joint contribution to the default mode network in predicting narcissistic personality traits.

Despite the clinical significance of narcissistic personality, its neural bases have not been clarified yet, primarily because of methodological limitations of the previous studies, such as the low sample size, the use of univariate techniques and the focus on only one brain modality. In this study, we employed for the first time a combination of unsupervised and supervised machine learning methods, to identify the joint contributions of grey matter (GM) and white matter (WM) to narcissistic personality traits (NPT). After preprocessing, the brain scans of 135 participants were decomposed into eight independent networks of covarying GM and WM via parallel ICA. Subsequently, stepwise regression and Random Forest were used to predict NPT. We hypothesized that a fronto-temporo parietal network, mainly related to the default mode network, may be involved in NPT and associated WM regions. Results demonstrated a distributed network that included GM alterations in fronto-temporal regions, the insula and the cingulate cortex, along with WM alterations in cerebellar and thalamic regions. To assess the specificity of our findings, we also examined whether the brain network predicting narcissism could also predict other personality traits (i.e., histrionic, paranoid and avoidant personalities). Notably, this network did not predict such personality traits. Additionally, a supervised machine learning model (Random Forest) was used to extract a predictive model for generalization to new cases. Results confirmed that the same network could predict new cases. These findings hold promise for advancing our understanding of personality traits and potentially uncovering brain biomarkers associated with narcissism.

Adult ADHD and pathological narcissism: A retrospective-analysis.

Adult attention deficit hyperactivity disorder (ADHD) is often associated with personality pathology. However, only few studies have been conducted on the link between ADHD and pathological narcissism (PN), with or without a diagnosis of narcissistic personality disorder (NPD). In order to fill this gap, PN and NPD were assessed in 164 subjects suffering from ADHD, with several other measures including ADHD severity, quality of life, depression, anxiety, impulsivity, and emotion dysregulation (ED). We found that a significant proportion of ADHD patients suffered from NPD, and that both narcissistic grandiosity and vulnerability were associated with ADHD hyperactivity and impulsivity symptoms, but not with inattentive symptoms. These two dimensions seemed to be negatively associated with well-being and positively associated with most of the other studied psychiatric dimensions except ED, the latter being only associated with vulnerability, even after adjustment on borderline symptoms. Overall, despite important limitations that limit the generalizability of our findings to the overall ADHD population (notably linked to selection bias), we believe that this exploratory study sheds light on the potential clinical relevance of narcissistic pathology in adult ADHD patients.

The Spanish Short Dark Tetrad (SD4): Association With Personality and Psychological Problems.

BACKGROUND: The Short Dark Tetrad (SD4) is a recently developed instrument for assessing the "dark" personality traits of psychopathy, narcissism, Machiavellianism, and sadism. We aimed to examine the SD4's psychometric properties, adapting it into Spanish and exploring its structure, gender invariance, reliability, concurrent validity, and nomological network. METHOD: A sample of 668 adults (Mage = 26.36, SD = 10.64, 69.2% females) completed the SD4 and other self-report questionnaires. RESULTS: The results demonstrated sound indices of reliability and concurrent validity, an adequate four-factor structure, and support for gender invariance. Furthermore, most of the findings about the nomological network were in line with prior hypotheses: All four SD4 scales were associated with low levels of agreeableness and antagonism; psychopathy was also related to low conscientiousness, disinhibition and impulse-control problems; narcissism was positively associated with extraversion and negatively associated with internalizing symptoms; Machiavellianism was uncorrelated with impulsivity-related problems, which made it distinct from the psychopathy profile; finally, sadism showed a similar pattern of associations to psychopathy, albeit less strongly linked to impulsivity problems and externalizing behavior. CONCLUSIONS: Overall, the SD4 presents sound psychometric properties, although the overlap between psychopathy and sadism warrants some caution.

Role of narcissism in parental alienation phenomenon. A narrative review.

Parental Alienation Syndrome (PAS) is a term addressed to describe negative, psychopathological feelings, thinking and behaviours, including hostility and fear, exhibited by children who have been alienated from one parent by the other parent. Despite its relevance in the clinical psychology field, theoretical and empirical contributions to understanding and deepening the many facets of this concept are still few. In particular, literature aimed at disentangling the alienating parent's psychological characteristics is scarce and fragmented. Our contribution encompasses a narrative review of scientific literature since the term PAS was coined in 1987 by Gardner, to delineate narcissistic proneness in alienating parents. Namely, considering the narcissistic drift the western society is going toward, we hypothesised that narcissism has a pivotal role in parents' alienating behaviours against the alienated ones. Firstly, the elements that emerged from our literature search confirmed our theoretical hypothesis, in terms of the likely role of narcissism/narcissistic marked traits in alienating parents. In the second section, we contextualised the phenomenon in a psychodynamic/psychoanalytic theoretical framework. Finally, based on previous findings/considerations, the developmental trajectories of children with PAS have been traced. An improved theoretical knowledge of this phenomenon, also in terms of the psychopathology associated with its genesis, means to refine the diagnostic and treatment tools to prevent it.

The differential effect of psychopathy on active and bystander trolling behaviors: the role of dark tetrad traits and lower agreeableness.

This study aimed to develop the Global Assessment of Active Trolling and Passive Bystanderism (GAATPB) scale and investigate the influence of personality traits on trolling behaviors. Focusing on the Dark Tetrad (DT) traits and agreeableness, the present study examined their associations and predictive utility on active trolling and passive bystanderism. Participants were recruited from social networking sites (SNSs), and eligibility criteria included active SNS usage and engagement in online interactions. A total of 797 healthy adult students participated in the study, with data from 300 used for the initial exploratory factor analysis (EFA) and the remaining 497 (Mage = 22.25 years, SD = 3.37) for the subsequent analyses. Results indicated a significant correlation between DT traits and agreeableness across both active trolling and passive bystanderism, revealing a shared personality profile. Hierarchical multiple regression analyses showed that narcissism, Machiavellianism, and trait sadism were predictors of active trolling, with psychopathy being the strongest predictor. However, psychopathy did not emerge as a predictor for passive bystanderism. The study also highlighted that DT traits mediated the relationship between lower agreeableness and overall trolling behavior, suggesting that trolling manifests from lower agreeableness through the instigation of callous-unemotional, manipulative, and self-centered traits inherent in DT.

Structure of resilience: A Machiavellian contribution or 'paddle your own canoe'.

According to biobehavioral synchronicity model, empathy-a fundamental requirement for reciprocal and prosocial behavior-is at the core of rebound from stress, an essential feature of resilience. However, there are also reports on antagonistic traits-characterized by empathic deficit-bolstering immunity to stress. In the literature there is also inconclusive evidence regarding gender-related differences in resilience. In separate female and male subsamples we analyzed the network constellation entailing resilience (assessed as rebound from stress), empathic (cognitive empathy, affective resonance, and affective dissonance) and antagonistic personality traits (Machiavellianism, grandiose- and vulnerable narcissism). For both genders, Machiavellian agency instigated by narcissistic admiration occupied the central position in the network indicating that personality's resources for proactivity and control are essential for successful rebound. Empathy, and in particular its affective component, occupied only a peripheral position in the network. Machiavellian antagonism in men and grandiose narcissism in females bridged prosocial mechanism of resilience with antagonistic nodes of the network. In the female subsample both types of malign narcissism (rivalry and vulnerable narcissism) directly thwarted rebound. This process was not detected in the male subsample network dominated by antagonism. That is, gender-related differences were associated with the avoidance strategies rather than with the proactive strategies. Thus, resilience assessed as rebounding from stress primarily involves personality resources which modulate proactive- and prosocial- but not necessarily reciprocal behavior.

Perfectionistic Self-Presentation and Psychopathology: A Systematic Review and Meta-Analysis.

Decades of research implicate perfectionism as a risk factor for psychopathology. Most research has focused on trait perfectionism (i.e., needing to be perfect), but there is a growing focus on perfectionistic self-presentation (PSP) (i.e., the need to seem perfect). The current article reports the results of a meta-analysis of previous research on the facets of PSP and psychopathology outcomes (either clinical diagnoses of psychiatric disorders or symptoms of these disorders). A systematic literature search retrieved 30 relevant studies (37 samples; N = 15,072), resulting in 192 individual effect-size indexes that were analysed with random-effect meta-analysis. Findings support the notion of PSP as a transdiagnostic factor by showing that PSP facets are associated with various forms of psychopathology, especially social anxiety, depression, vulnerable narcissism and-to lesser extent-grandiose narcissism and anorexia nervosa. The results indicated that there both commonalities across the three PSP and some unique findings highlighting the need to distinguish among appearing perfect, avoiding seeming imperfect and avoiding disclosures of imperfections. Additional analyses yielded little evidence in the results across studies including undergraduates, community samples and clinical samples. Our discussion includes a focus on factors and processes that contribute to the association between PSP and psychopathology.

Impulsivity mediates the association between narcissism and substance-related problems beyond the degree of substance use: a longitudinal observational study.

BACKGROUND: Narcissism has been implied as a putative risk factor for substance use disorders (SUDs). However, previous research did not disentangle the degree of substance use from substance-related problems, the symptoms of SUDs. This preregistered study addressed the open question whether grandiose and vulnerable narcissism and their constituent traits convey specific SUD risk, that is, explain substance-related problems beyond the degree of use. Furthermore, we tested whether impulsivity or substance use motives linked to narcissistic self-regulation mediate this association. METHODS: Narcissism, impulsivity, substance use motives, past-year substance use, and substance-related problems were assessed in 139 (poly-)substance users, 121 of whom completed a one-year follow-up. For significant longitudinal associations between narcissism factors and substance-related problems controlled for the degree of use, we tested impulsivity and substance use motives as mediators. RESULTS: Grandiose narcissism (r =.24, p =.007) and its constituent factors antagonistic (r =.27, p =.003) and agentic narcissism (r =.18, p =.050), but not vulnerable narcissism, prospectively predicted substance-related problems beyond the degree of substance use. Associations of grandiose narcissism and antagonistic narcissism with substance-related problems were fully mediated by impulsivity, but not substance use motives. Impulsivity explained roughly one third of the association of both grandiose (P̂M = 0.30) and antagonistic narcissism (P̂M = 0.26) with substance-related problems. DISCUSSION: We demonstrate that grandiose narcissism- particularly antagonistic but also agentic narcissism- is specifically linked to substance-related problems beyond the degree of substance use. The mediating effect of impulsivity but not substance use motives suggests that impulsivity may be a more important mechanism than narcissistic self-regulation in promoting SUD in narcissism. However, future studies may use more targeted measures than substance use motives to further probe the role of self-regulation. Similar result patterns for alcohol compared to all substances together indicate that mechanisms may be alike across substances. In conclusion, narcissistic individuals may not use substances more but have a higher SUD risk, informing prevention and treatment.