Narcissism and Narcissistic Personality Disorder 1 Running Head: Narcissism and Narcissistic Personality Disorder Narcissism and Narcissistic Personality Disorder: Moving toward a trifurcated model Michael L. Crowe Brandon Weiss Donald R. Lynam W. Keith Campbell Joshua D. Miller Narcissism and Narcissistic Personality Disorder 2 Abstract This chapter reviews the current state of the narcissism and NPD literature highlighting areas of progress, points of continued debate, and areas for future research. After a brief review of narcissism’s origins, current conceptualizations of the construct are discussed beginning first with NPD and continuing with narcissism’s grandiose and vulnerable dimensions. Grandiose narcissism represents the prototypical manifestation of the construct, while vulnerable narcissism is more commonly observed in clinical settings. A review of grandiose and vulnerable narcissisms’ nomological networks makes it clear that both manifestations can yield significant impairment, albeit of different forms. Converging evidence for a three-dimensional (i.e., “trifurcated”) model of narcissism, which allows for an integrated understanding of its grandiose and vulnerable dimensions is presented. We argue that general application of the trifurcated model is necessary to provide further clarity to the narcissism literature. The “oscillation hypothesis” (i.e., that narcissistic individuals fluctuate between grandiose and vulnerable presentations) is highlighted as an area of continued debate and emerging measures capable of investigating narcissistic fluctuation are identified. The chapter concludes with a review of self- report measures of narcissism and recommendations using the trifurcated model to guide scale selection decisions. Keywords: NPD, grandiose narcissism, vulnerable narcissism, personality pathology, trifurcated model, Narcissism Spectrum Model Narcissism and Narcissistic Personality Disorder 3 Narcissism and Narcissistic Personality Disorder: Moving toward a trifurcated model Narcissism has been a subject of psychological interest for over a century (Sadger, 1908). Narcissism has historically been characterized by a combination of antagonistic traits including grandiosity, callousness, manipulativeness, and entitlement. However, despite a century of empirical inquiry, a consensually accepted definition of the construct, its etiological factors, and conceptual boundaries have yet to be established, although we will argue in this chapter that the traits associated with narcissism are relatively well-agreed upon (see Table 1). This is not to suggest that little empirical work on this construct has been done or to deny the clear progress that has been made, especially over the past 10-15 years. The field is at an odd point: scientific research on narcissism is thriving and yet narcissistic personality disorder (NPD) was one of five PDs slated for deletion from the DSM-5 due in part to the notion that it was uncommon, under-researched, and only moderately impairing. Ultimately, it was preserved as a full-fledged diagnostic construct in DSM-5 Section III due to clinicians’ “bemoaning” its deletion because of its perceived clinical utility (Skodol, 2012, p. 331). Others, ourselves included, argued that NPD should be included in part because it had a far larger research literature than the DSM-5 Personality and Personality Disorder Work Group considered in its initial review (Miller, Widiger, & Campbell, 2010) and has many important consequences, not just for narcissistic individuals but for those around them (e.g., Miller, Campbell, & Pilkonis, 2007) – a criterion that some believe should be considered as a diagnostic marker along with distress and self-related impairment (Pilkonis et al., 2011). Since 2000, over 2000 peer reviewed articles have been published in which “narciss*” is in the title – compared to just over 1000 such Narcissism and Narcissistic Personality Disorder 4 articles from 1980 to 1999. 1 A critical advance over the past 20 years is the recognition that narcissism is not monolithic (Cain, Pincus, & Ansell, 2008; Miller & Campbell, 2008; Wink, 1991). Failure to consistently recognize separable conceptualizations and related assessments has yielded a muddied empirical literature that has made it difficult to develop a coherent and cohesive construct (e.g., Miller et al., 2011). Today, these conceptions are typically referred to as grandiose narcissism and vulnerable narcissism, modern labels for distinctions that have long been recognized by clinical theorists under a variety of terms (see Cain et al., 2008, for a review): manipulative, overt, egotistical, thick-skinned, exhibitionistic, elitist for grandiose; and covert, contact-shunning, thin-skinned, hypervigilant, shy, compensatory for vulnerable. Grandiose narcissism is associated with a grandiose sense of self, entitlement, aggression, emotional resilience, and interpersonal dominance. Vulnerable narcissism is associated with an egocentric interpersonal style that is paired with intense negative affectivity, low self-esteem, and feelings of inadequacy. Like grandiose individuals, vulnerable narcissism is associated with egotism and self-enhancing fantasies, but instead of interpersonal dominance, vulnerably narcissistic individuals tend to be more socially passive, withdrawn, and hypersensitive to criticism. The common traits that link the grandiose and vulnerable domains are a topic of debate, but converging arguments have been made for antagonism (or facets thereof such as entitlement and self-importance) as the “core” that connects the two narcissism dimensions (Crowe, Lynam, Campbell, & Miller, 2019; Krizan & Herlache, 2018; Miller, Lynam, Hyatt, & Campbell, 2017). 1 Search completed on 4/16/19. Narcissism and Narcissistic Personality Disorder 5 The present review begins with a description of early conceptualizations of narcissism, and proceeds with a description of how narcissism has been conceptualized and understood over the past few decades. We review the evolution of models containing narcissistic personality disorder (NPD), grandiose and vulnerable narcissism, as well as more recent unified models of narcissism that include three dimensions from basic personality. Early Conceptualizations of Narcissism: The “Mask Model” Early conceptualizations of narcissism were complex and varied (see Levy, Ellison, & Reynoso, 2012 for review), but most included many of the outward traits that are consensually understood to make up narcissism today. The focus of early psychoanalytic theorists was on narcissism’s unseen etiological elements that are difficult to measure. Two of the most prominent psychodynamic scholars on the subject, Otto Kernberg (1975) and Heinz Kohut (1972), despite their different perspectives on the construct (Russell, 1985), agreed that narcissistic tendencies emerge in childhood as a normal part of development but can persist and become pathological under conditions of a defective sense of self (Ronningstam, 2012). Like many psychodynamic theories, early attachment experiences were thought to be key in the etiological process. It was argued that problematic parenting could lead to internalized feelings of inferiority and that overt grandiosity emerged to protect against such insecurities. This theory, that the grandiose attitudes expressed among narcissistic individuals are only a thin façade developed to protect deep-seated, perhaps unconscious feelings of inferiority, is known as the psychodynamic mask model and the topic has been subject to considerable examination (see Kuchynka & Bosson, 2018; Zeigler-Hill & Jordan, 2011 for review). Given the implicit nature of narcissistic fragility that is implied by the mask model, the theory is difficult to directly evaluate. However, attempts have been made using the Implicit Narcissism and Narcissistic Personality Disorder 6 Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998) and Name Letter Task (NLT; Kitayama & Rarasawa, 1997), both paradigms that were developed to assess automatic attitudes without interference from conscious awareness and manipulation. The mask model has not fared well empirically. Assuming the mask model implies an inconsistency between explicit self- esteem (i.e., conscious feelings towards the self) and implicit self-esteem (i.e., automatic, uncontrolled feelings towards the self), there is little support for the model. A meta-analysis examining both published and unpublished data revealed no consistent support for the prediction that narcissism is best characterized by a combination of high explicit and low implicit self- esteem (Bosson et al., 2008). However, efforts to show that narcissism is associated with positive implicit agentic self-views (Campbell, Bosson, Goheen, Lakey, & Kernis, 2007) have also not replicated (Fatfouta & Schröder-Abé, 2018). The mask model remains popular among clinicians and lay conceptualizations but empirical evidence for it is thin at best. As such, much of this chapter takes a more descriptive approach in which internal and perhaps unconscious motivations and feelings are largely eschewed. Narcissistic Personality Disorder in the DSM Although interest in narcissism long precedes its inclusion in official psychiatric taxonomies such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), its inclusion in the 1980 DSM-III lent credibility and spurred further empirical study in both clinical (i.e., as a personality disorder) and non-clinical (i.e., as a dimensional personality construct) settings.