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. Two separate diagnostic approaches for NPD (and several other PD constructs) are provided in the DSM-5 (APA, 2013; see also Skodol, Bender, & Morey, 2014) due to scientific, political, and personal disagreements about the best approaches to the diagnosis of personality disorders (e.g., Skodol, 2012; Widiger, 2013). NPD’s formal diagnostic criteria are the same as Narcissism and Narcissistic Personality Disorder 7

they were in DSM-IV and are provided in the main body text (i.e., Section II) where it is one of

10 formal PDs. NPD is described as “a pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning in early adulthood and present in a variety of contexts” (APA, 2013, p. 669). The specific diagnostic criteria can be summarized as follows: grandiose sense of self-importance, preoccupation with fantasies of success or power, belief that one is “special” and should affiliate with other “special” people, need for admiration, sense of entitlement, interpersonally exploitative, lack of empathy, often envious or believes he/she is the target of envy, arrogant (APA, 2013). A diagnosis of NPD requires that an individual meet 5 of 9 criteria and that the symptoms result in distress and/or impairment. NPD is considered one of four “Cluster B Personality disorders” alongside antisocial, borderline and histrionic PDs, which all contain externalizing or antagonistic behaviors (e.g., Kotov et al., 2017).

Empirical examination of the NPD diagnostic criteria suggests that they capture primarily the grandiose dimension of narcissism. For instance, factor analyses suggest that most or all the criteria load onto the grandiose domain (Fossati et al., 2005; Miller, Hoffman, Campbell, &

Pilkonis, 2008). NPD’s meta-analytic personality trait profile suggests that it is nearly identical

(r = .97) to the meta-analytically derived trait profile of grandiose narcissism, but only moderately associated (r = .39) with the meta-analytically derived trait profile of vulnerable narcissism (Miller, Lynam, Siedor, Crowe, & Campbell, 2018). Although the diagnostic criteria emphasize narcissistic grandiosity, the text description does include explicit references to emotional vulnerability consistent with vulnerable narcissism:

Vulnerability in self-esteem makes individuals with narcissistic personality disorder very

sensitive to “injury” from criticism or defeat. Although they may not show it outwardly,

criticism may haunt these individuals and may leave them feeling humiliated, degraded, Narcissism and Narcissistic Personality Disorder 8

hollow, and empty (APA, 2013, p. 671).

Also, it is important to note that while the criteria are “grandiose” in nature, many self-report measures of NPD yield an empirical profile more aligned with vulnerable narcissism (e.g.,

Hopwood et al., 2013; Miller et al., 2014). This is likely due to the wording used in self-report measures of NPD that inadvertently pulls for such content (e.g., “I very much need other people to take notice of me or compliment me;” Personality Diagnostic Questionnaire-4; Hyler, 1994).

A second diagnostic system is provided in Section III (i.e., Emerging Measures and

Models) of the DSM-5, which is called the Alternative Model of Personality Disorders (AMPD).

The DSM-5 Personality and Personality Disorder Work Group proposed this model as the one and only official model, in line with calls by the Chair of DSM-5 to make large, substantive changes where necessary, but it was placed in Section III instead, a section devoted to experimental models requiring further validation (Skodol, 2013). This model has two primary components – the requirement that one demonstrate (a) personality dysfunction in self and interpersonal domains and (b) the presence of one or more (of 25) pathological traits. The latter

25 traits covary in such a manner as to yield a five-factor model that is roughly aligned with Big

Five/Five Factor Models of general personality (e.g., Gore & Widiger, 2013; Thomas et al.,

2013). In the Section III model, an NPD diagnosis requires personality dysfunction (Criterion A) as indicated by: 1) excessive reference to others for self-esteem regulation or vacillation between self-esteem extremes; 2) unreasonably high or low personal standards due to the need to see oneself as exceptional or a sense of entitlement; 3) difficulty sympathizing with the feelings or needs of others; 4) shallow relationships that serve as means of self-esteem regulation (APA,

2013). It also requires elevations on two pathological personality traits (Criterion B): grandiosity

(i.e., entitlement, egotism) and attention seeking (i.e., need for admiration and attention). Narcissism and Narcissistic Personality Disorder 9

The Section III text description of NPD acknowledges the possibility of heterogeneous presentations, consistent with a robust literature that has accrued since the publication of DSM-

IV, indicating that typical features can include “either overt or covert grandiosity” (APA, 2013, p. 767). What is noteworthy of this model is that Criterion B includes only 2 of the 25 pathological traits (i.e., grandiosity and attention seeking) which is the fewest number of specified traits for the six diagnosed AMPD PDs. NPD criteria were limited to only these traits to minimize its overlap with antisocial personality disorder (Skodol, Bender, & Morey, 2014), but these traits alone may provide incomplete coverage of the NPD construct. What coverage is provided by the Criterion B traits clearly emphasizes the grandiose dimension. Together, grandiosity and attention seeking account for 63% of the variance in measures of grandiose narcissism, but only 19% of the variance in measures of vulnerable narcissism (Miller, Gentile,

Wilson, & Campbell, 2013). Traits relevant to the vulnerable dimension were excluded because their inclusion would have increased the prevalence of NPD while decreasing the internal consistency of its criteria set and its discriminant validity with respect to borderline personality disorder and schizotypal personality disorder (Skodol, Bender, & Morey, 2014). There is sufficient support for a range of additional pathological traits already included in the Section III model (e.g., manipulativeness, callousness, hostility) all of which have been indicated as relevant to NPD by expert ratings (Ackerman, Hands, Donnellan, Hopwood, & Witt, 2017; Lynam &

Widiger, 2001; Samuel, Lynam, Widiger, & Ball, 2012), relations with the FFM (Samuel &

Widiger, 2008a), and by work evaluating emotional reactivity in some narcissistic individuals

(Gore & Widiger, 2016; Hyatt et al., 2018). Currently, the Section III model allows for trait specifiers which “may be used to record additional personality features that may be present in

[NPD] but are not required for the diagnosis” (APA, 2013, p. 768). Such specifiers allow for Narcissism and Narcissistic Personality Disorder 10

recognition of heterogeneity in narcissistic presentation and can be used to supplement an NPD diagnosis with additional pathological traits currently absent in Criterion B, or to indicate the presence of traits relevant to vulnerable presentations (e.g., depressivity, anxiousness). It is possible that relegating relevant traits to “specifier” status may have sacrificed some level of diagnostic validity in the service of flexibility. That being said, the data suggest that the traits currently included in Criterion B (i.e., grandiosity, attention seeking) are among the most prototypical of NPD (Lynam & Widiger, 2001; Samuel & Widiger, 2004; Samuel et al., 2012).

Clinical Presentation of NPD

One factor that contributes to ostensible differences in NPD’s structure is the sampling conditions under which NPD is studied. When examined in clinical settings, NPD appears distinct from an NPD profile characterized largely by attention-seeking and grandiosity. While some “core” narcissistic traits (e.g., hostility, manipulativeness) are prominent across samples, many of the prototypical NPD traits (e.g., grandiosity, exhibitionism) are relatively rare in clinical samples. Generic clinical samples (i.e., individuals seeking mental health treatment) have shown NPD presentations that more prominently feature traits characteristic of the vulnerable dimension (e.g., anxiety, anhedonia) rather than the features present in its more typical presentations (e.g., grandiosity, callousness, dominance). For instance, analyses of NPD in inpatient samples have demonstrated significant comorbidity with affective disorders (66%;

Morf et al., 2017) and borderline PD (Vater et al., 2013), neither of which have FFM profiles similar to that of prototypical NPD.

The unique presentation of NPD in clinical samples has led some to argue for a distinction between “normal” and “pathological” narcissism (Pincus & Lukowitsky, 2010). We suggest the differences in profile between non-clinical and clinical populations are better Narcissism and Narcissistic Personality Disorder 11

characterized by differences in grandiose (non-clinical) and vulnerable (clinical) expressions, and would challenge the claim that grandiose narcissism, which is more closely aligned with

NPD, represents a non-pathological or “adaptive” expression. To make such an argument equates pathology with subjective distress, and neglects that grandiose and vulnerable expressions of narcissism are both associated with impairment, though of different types. Vulnerable narcissism, more commonly observed in clinical settings, is associated with internalizing behaviors and significant subjective distress. It is for this reason that vulnerable individuals likely present to clinical settings. Although grandiose narcissism is not associated with emotional distress, it associated with externalizing behaviors including aggression, risky decision making, infidelity, and impairment in intimate relationships (Campbell, Rudich, & Sedikides, 2002;

Krizan & Johar, 2015; Lavner, Lamkin, Miller, Campbell, & Karney, 2016; Miller, Campbell, et al., 2009; Miller, Widiger, & Campbell, 2010) and other important diagnostic constructs (e.g., psychopathy; Krusemark, Campbell, Crowe, & Miller, 2018).

Clinical presentations of narcissism are certainly of interest, but to over-emphasize such samples is to neglect an expression of NPD that is at least equally important. The traits most commonly associated with prototypical NPD are more commonly found in community rather than clinical samples (Morf et al., 2017). If grandiose expressions of NPD are of interest, it may be more appropriate to utilize forensic, offender, or corporate samples. We have noted previously

(Miller et al., 2017) that little to no theoretical or empirical work on antisocial PD or psychopathy has been done in clinical settings and yet these constructs are clearly of substantial social, forensic, and even clinical interest. Given that these are near neighbor disorders (Miller et al., 2017), it is all the more surprising that their literatures employ such disparate sampling approaches (i.e., ASPD /psychopathy: offender samples considered the “gold standard” by many; Narcissism and Narcissistic Personality Disorder 12

narcissism/NPD: clinical samples considered the gold standard by many). There may be benefits to studying vulnerable narcissism in clinical settings but the selection bias intrinsic in this setting means generalizability will likely be limited and that more work in narcissism is needed in settings where higher levels of grandiose narcissism may be found (e.g., offender and corporate samples).

The Five Factor Model Framework for Understanding NPD and Narcissism

The five-factor model and NPD. Much of modern researchers’ understanding of NPD’s structure emanates from the use of frameworks developed outside the clinical literature, most notably using the trait framework of the Five-Factor Model (FFM; Costa & McCrae, 1992) of personality. In Samuel and Widiger’s (2008a) meta-analytic investigation of NPD’s association with the FFM (see Table 1), notable relations were found with low levels of Agreeableness (r = -

.34), in particular Modesty (r = -.37), Straightforwardness (r = -.31), and Compliance (r = -.26).

Other notable associations are with Angry Hostility (r = .23), a facet of neuroticism predictive of interpersonal distress, and Assertiveness (r = .19), a facet of extraversion associated with interpersonal dominance. Importantly, the NPD FFM profile described by Samuel and Widiger

(2008) is consistent with that expected by academics familiar with narcissism (r = .81; Lynam &

Widiger, 2001), clinicians (r = .87; Samuel & Widiger, 2004), and the lay-person’s characterization of narcissism (r = .82; Miller et al., 2018), suggesting that there is a general consensus – empirical and theoretical – of the traits that comprise narcissism/NPD.

The five-factor model and grandiose and vulnerable narcissism. The heterogeneity of traits that comprise NPD makes a single characterization of the construct problematic. Although narcissistic heterogeneity has been observed for many years (Cain et al., 2008), it was not until relatively recently that the two domains were measured and examined empirically with any Narcissism and Narcissistic Personality Disorder 13

regularity. Grandiose and vulnerable narcissism have consistently shown distinct FFM profiles

(e.g., Campbell & Miller, 2013). Generally, grandiose and vulnerable narcissism can be distinguished by their differential relations with facets of extraversion and neuroticism.

Examination of their facet level associations reveals both the overlap and divergence of the constructs (see Table 1). Vulnerable narcissism has uniquely strong associations with nearly all facets of neuroticism (i.e., anxiety, depression, self-consciousness, impulsiveness, vulnerability)

(Miller, Hoffman, et al., 2011; Miller et al., 2017). The only exception to this rule is the facet of angry hostility, which grandiose narcissism also correlates positively with albeit to a lesser extent

(Krizan & Johar, 2015; Weiss & Miller, 2018). However, previous findings suggest that grandiosely narcissistic individuals are particularly prone to anger in response to ego threats

(Gore & Widiger, 2016; Hyatt et al., 2018).

Individuals who score high on grandiose narcissism have been described as “disagreeable extraverts” (Paulhus, 2001), but at the facet level, its association is clearly limited to a subset of the domains. Extraversion can be parsed into at least two subcomponents: agentic and communal. Grandiose narcissism has a particular association with the agentic facets of the domain (e.g., assertiveness, risk taking), and much less so for the communal components, which relate to a drive for interpersonal connectedness (e.g., warmth; positive emotions).

Grandiose and vulnerable narcissism share a common association with the agreeableness domain, but at the facet level their associations are somewhat unique. Narcissistic grandiosity has particular associations with manipulativeness (i.e., low straightforwardness) and immodesty, while narcissistic vulnerability’s association with antagonism seems to be driven primarily by the tendency to distrust others (Campbell & Miller, 2013; O’Boyle, Forsyth, Banks, Story, & White,

2015) and a much smaller (than grandiose narcissism) link to immodesty. This is consistent with Narcissism and Narcissistic Personality Disorder 14

previous speculation (Miller, Dir, et al., 2010) that individuals high on vulnerable narcissism may manifest a hostile attribution bias making them prone to interpreting the actions of others as malevolent. It is possible that fundamentally unique functional processes may play a role in maintaining antagonistic behaviors in grandiose and vulnerable narcissism: a hostile attribution bias in vulnerable narcissism, immodesty and need for self-enhancement in grandiose narcissism

(Hopwood, 2018).

The Nomological Network of Grandiose and Vulnerable Narcissism

Consistent with their different trait profiles, grandiose and vulnerable narcissism have divergent nomological networks as well. What follows is a review of additional correlates relating to etiological factors, self-esteem, interpersonal functioning, work, externalizing behaviors, internalizing symptoms, and psychopathology broadly construed.

Etiology. The etiology of narcissism remains unclear with contradicting evidence from theoretical and empirical perspectives. In terms of environmental contributions, many prominent theories emphasize the importance of early childhood events in the development of narcissistic traits (see Thomaes & Brummelman, 2018 for complete review of narcissism socialization).

Kernberg (1975) and Kohut (1977) agreed that cold, nonvalidating, or dismissive parenting may lead to the development of narcissistic traits. Such theories are in line with the mask model in their assumption that narcissistic self-presentations are compensations intended to hide an underlying sense of fragility. More recent social learning theorists have suggested that narcissistic traits may arise as a result of parental overvaluation (i.e., treating children as more special and entitled than others; Brummelman et al., 2015; Thomaes & Brummelman, 2018).

Overvaluing parents are more likely to overestimate and overpraise the qualities of their children and are more likely to attempt to make them stand out in a crowd (Brummelman, Thomaes, Narcissism and Narcissistic Personality Disorder 15

Nelemans, Orobio de Castro, & Bushman, 2015). The theory being that overvaluation or reinforcement that is not contingent on behavior may lead the individual to develop a grandiose sense of self, expectations of adulation and special treatment, and a tendency to react with hostility when those expectations are not met (Millon, Grossman, Millon, Meagher, & Ramnath,

2004). Parental overvaluation is understood as distinct from parental warmth (i.e., expression of affection and appreciation). Neither of these two theoretical pathways (i.e., overvaluation, parental coldness/low warmth) has undergone a great deal of empirical examination to date and many reported data have relied primarily on retrospective self-report, which is an important limitation. Retrospective findings indicate that grandiose and vulnerable presentations may have unique etiological pathways. When compared to grandiose narcissism, vulnerably narcissistic individuals report experiencing higher levels of verbal, emotional, and physical abuse (Miller,

Hoffman, et al., 2011), more intrusive parenting, and lower levels of parental warmth (Barry,

Lakey, & Orehek, 2007; Miller, Hoffman, et al., 2011; Otway & Vignoles, 2006). No such developmental events or parenting practices have been clearly indicated as environmental etiological factors for grandiose narcissism, but inconsistent effects have been found for lower levels of parental monitoring, and higher levels of parental warmth and overvaluation (Horton,

Bleau, & Drwecki, 2006; Otway & Vignoles, 2006). Relatedly, only vulnerable narcissism seems to be associated with pathological adult attachment styles (i.e., anxious, avoidant) with grandiose narcissism showing no such association (Miller, Dir, et al., 2010; Miller, Hoffman, et al., 2011)

In the few prospective studies that have been completed, null to small effects have been observed between parenting practices and adult narcissism. Only one prospective study we are aware of has directly compared competing theories of narcissistic development (Brummelman,

Thomaes, Nelemans, Orobio de Castro, Overbeek, et al., 2015). Brummelman and colleagues Narcissism and Narcissistic Personality Disorder 16

(2015) used a prospective approach to compare the social learning theory perspective on narcissistic development (i.e., narcissism is cultivated by parental overvaluation) to the psychodynamic perspective (i.e., narcissism is cultivated by a lack of parental warmth). Only parental overvaluation, not warmth, predicted the development of grandiose traits, though effects were relatively small. The same analyses indicated that parental warmth predicted increases in children’s self-esteem over time while overvaluation did not (Brummelman, Thomaes,

Nelemans, Orobio de Castro, Overbeek, et al., 2015). Structured observations of parent-child interactions indicated that inflated praise was associated with the development of more narcissistic traits among children with high self-esteem suggesting that such inflated praise may be a specific mechanism through which parental overvaluation yields narcissistic tendencies

(Brummelman, Nelemans, Thomaes, & Orobio de Castro, 2017).

While the specific etiological pathways toward narcissism have not yet been identified, prospective analyses on the stability of narcissistic traits (e.g., antagonism, impulsivity, attention seeking) suggest that they emerge early in life (i.e., preschool age) and are relatively stable into adulthood (Carlson & Gjerde, 2009). Findings from behavioral genetic suggest that traits that comprise grandiose narcissism (e.g., grandiosity, entitlement, exploitativeness, exhibitionism) stem from non-shared environments and genetic factors (see Luo & Cai, 2018 for review).

Associations with self-esteem. Self-esteem is typically defined as an overall evaluative judgment about the self that can range from positive to negative. There have been many competing theories related to the role of self-esteem in narcissism, and it remains an area of active debate (Miller et al., 2017). The divergent theories can be somewhat separated by field of study, with social/personality psychologists generally conceptualizing stable, high self-esteem as more characteristic of narcissism than clinical psychologists who tend to view self-esteem Narcissism and Narcissistic Personality Disorder 17

vacillations as more central to the construct (Ackerman et al., 2017; Miller & Campbell, 2008).

When narcissism is evaluated as a single factor, the association between narcissism and self- esteem seems negligible (Crowe et al., 2019). Much of the confusion around narcissism’s relation with self-esteem has likely emerged as a result of failure to account for narcissism’s grandiose and vulnerable expressions.

Grandiose narcissism has been consistently associated with high explicit self-esteem

(Sedikides, Rudich, Gregg, Kumashiro, & Rusbult, 2004). Indeed, it is unclear how the association could be otherwise given grandiose narcissism’s association with arrogance, attention-seeking, superiority, and other aspects of self-enhancement. It is likely that many of the

“adaptive” aspects of grandiose narcissism (e.g., negative association with internalizing psychopathology) are attributable to its association with high self-esteem, which appears to be a near universally adaptive construct (Hyatt, Sleep, Lamkin, et al., 2018). However, while high self-esteem seems to be necessary for grandiose narcissism, it is not sufficient for the construct to emerge (Crowe, Sleep, Carter, Campbell, & Miller, 2018). Grandiose narcissism and self-esteem have a shared association with agentic aspects of extraversion, but they are clearly distinguishable; indeed, self-esteem is generally unrelated to antagonistic and externalizing behaviors whereas grandiose narcissism is associated with entitled, denigrating, and aggressive conduct towards others. One way to understand this divergence may involve differences in the ways those high in self-esteem and grandiosity view others in relation to the self (see

Brummelman, Gürel, Thomaes, & Sedikides, 2018 for review). Both self-esteem and narcissism are associated with ambition, but only narcissism is associated with a “zero sum” interpersonal approach that necessitates others be put down in order to lift up oneself. The distinct core beliefs predictive of self-esteem and narcissism likely arise at an early age and are further socialized by Narcissism and Narcissistic Personality Disorder 18

experience.

Vulnerable narcissism and self-esteem have consistently shown a strong negative association (Miller, Dir, et al., 2010; Miller, Hoffman, et al., 2011). It is therefore no surprise that associations between narcissism and self-esteem have historically been a topic of debate.

The extent to which measures of narcissism contain grandiose and vulnerable content largely determines the magnitude and direction of the relation between narcissism and self-esteem.

Interpersonal correlates. Narcissism has been associated with a range of both positive and negative interpersonal correlates. Much of this research has emerged from social/personality psychology, which emphasizes the grandiose narcissism dimension. There is therefore relatively little work directly looking at the interpersonal correlates of vulnerable narcissism, but grandiose and vulnerable narcissism’s differential associations with the FFM provides a scaffold for understanding the two constructs from an interpersonal perspective. NPD is substantially associated with distress in significant others. This is true even when controlling for other antagonistic personality disorders (i.e., Cluster B PDs; Miller, Campbell, & Pilkonis, 2007). As both grandiose and vulnerable narcissism share relatively similar associations with antagonistic behavior, it seems reasonable to assume that such interpersonal impairment is representative of both grandiose and vulnerable expressions. However, interpersonal correlates of the two dimensions likely diverge as a result of their unique associations with extraversion and neuroticism. The Interpersonal Circumplex (IPC; Wiggins, 1995) is a valuable lens for understanding narcissism’s interpersonal correlates. The IPC organizes interpersonal behavior into two orthogonal dimensions: love (e.g., interpersonal warmth), dominance (e.g., assertiveness, desire for control). While both grandiose and vulnerable narcissism are associated with low levels of love, the two dimensions diverge in their association with dominance, with Narcissism and Narcissistic Personality Disorder 19

grandiose narcissism affiliated with high levels of dominance and vulnerable narcissism associated with low levels (Miller, Hoffman, et al., 2011; Weiss, Campbell, Lynam, & Miller,

2019).

Grandiose narcissism’s interpersonal correlates are “two-sided” in that it is associated with both positive and negative interpersonal outcomes (Back, Schmukle, & Egloff, 2010; Back et al., 2013). What positive outcomes that have been observed for grandiose narcissism likely stem from its association with self-esteem and agentic aspects of extraversion. Vulnerable narcissism, on the other hand, seems to be somewhat more “one-sided” and purely maladaptive in nature.

Dating and relationships. Grandiosely narcissistic individuals tend to be perceived in a way that is initially positive, but this likeability diminishes over time and additional encounters

(Paulhus, 1998). Research on romantic relationships has shown a similar effect. Grandiose individuals are initially seen as desirable partners. They are outgoing, confident, charming, and concerned about their physical appearance (Back, Schmukle, & Egloff, 2010; Miller &

Campbell, 2008). They are also more likely to approach and engage with potential romantic partners due to their arrogance and reward motivation. Grandiose narcissism is therefore associated with higher levels of initial dating success, but decreased success and increased conflict over time (Brunell & Campbell, 2011; Wurst et al., 2017). Grandiosely narcissistic individuals are prone to “game-playing” in relationships, infidelity, and less emphasis on emotional intimacy (Brunell & Campbell, 2011; Campbell & Foster, 2002). Beyond their lack of intimacy, narcissism is associated with interpersonal exploitation, selfishness, insensitivity, and self-serving social cognitions leading them to take personal credit for successes but blame others for failure (Campbell, Bonacci, Shelton, Exline, & Bushman, 2004; Rhodewalt & Morf, 1998; Narcissism and Narcissistic Personality Disorder 20

Wurst et al., 2017). As a result, relationships with grandiosely narcissistic individuals tend to be shallow, lacking in commitment, and mired with conflict.

Regarding partner selection in romantic relationships, there is some evidence for homophily (i.e., selecting an intimate partner with similar traits) among narcissistic individuals, but the effect is small and seems to be largely limited to grandiose traits (Keller et al., 2014;

Lamkin, Campbell, vanDellen, & Miller, 2015; Lavner et al., 2016). Evidence for victim- oriented partner selection (i.e., that narcissistic individuals select partners who may be vulnerable or easier to manipulate) has been even more limited (Lavner et al., 2016). There has been a relative dearth of relationship research specific to vulnerable narcissism, but vulnerable narcissism’s negative association with extraversion and low self-esteem would indicate that it is unlikely to share grandiose narcissism’s short-term relationship benefits. Their shared association with antagonism however, and vulnerable narcissism’s uniquely strong association with distrust, would indicate that it is associated with similar interpersonal conflict within romantic relationships. Both grandiose and vulnerable narcissism are associated with problematic “game playing” and possessive love styles (Miller, Gentile, & Campbell, 2013;

Weiss et al., 2019), and the likelihood for distress in relationships with vulnerably narcissistic individuals is exacerbated by its association with maladaptive adult attachment (Kaufman,

Weiss, Miller, & Campbell, in press; Miller, Hoffman, et al., 2011), which is not observed in grandiose narcissism.

In the workplace. Grandiose narcissism also has “two-sided” effects in the workplace.

Grandiose individuals are more likely to emerge as leaders in group discussions (Brunell et al.,

2008) and are more likely to seek out and “emerge” in leadership positions in the workplace

(Sedikides & Campbell, 2017). Grandiose leaders’ self-confidence and boldness can be Narcissism and Narcissistic Personality Disorder 21

associated with positive outcomes due to their willingness to pursue ambitious goals (Nevicka,

2018; Sedikides & Campbell, 2017). However, narcissistic individuals are prone to overconfidence, they overestimate their knowledge, and have a harder time learning from feedback (Campbell, Goodie, & Foster, 2004). In her recent review of narcissism and leadership,

Nevicka (2018) reported that grandiose individuals can be prone to poor decision making through a range of self-serving cognitive and behavioral process (e.g., only listening to information and advice that they want to hear, dominating discussion among coworkers, desire for recognition leading to pursuit of risky projects or investments). Relatedly, in their Energy

Clash Model of narcissism and organizational change, Sedikides and Campbell (2017) review the ways in which narcissistic leaders may initially benefit an organization through excitement and change, but ultimately yield conflict within a previously stable organizational system. Along with a propensity for risky decision making, grandiose leaders are entitled, self-serving, and prone to a range of unethical workplace behaviors (Judge, Piccolo, & Kosalka, 2009). Meta- analytic reviews suggest leadership effectiveness may be highest at moderate levels of narcissism, with lower levels of effectiveness among non-narcissistic and highly narcissistic individuals (Grijalva, Harms, Newman, Gaddis, & Fraley, 2015). It seems possible that at this moderate level the benefits of narcissism’s agentic components (e.g., assertiveness, self- confidence) can emerge while limiting the adverse effects associated with narcissism’s antagonistic components (this more articulated breakdown of narcissism, into three components, is discussed in greater detail later in the chapter). Again, research in this domain is largely limited to measures of grandiose narcissism.

Externalizing behavior. Grandiose and vulnerable narcissism have differential associations with a range of externalizing behaviors including pathological gambling, alcohol Narcissism and Narcissistic Personality Disorder 22

use, antisocial behavior, aggression, and histrionic behaviors such that grandiose narcissism is typically a stronger correlate of these behaviors (Lakey, Rose, Campbell, & Goodie, 2008;

Luhtanen & Crocker, 2005; Miller, Hoffman, et al., 2011; Miller, Widiger, et al., 2010; Vize,

Collison, Crowe, et al., 2019). This is likely the result of grandiose narcissism’s association with an excessively active reward-oriented system (Foster & Trimm, 2008) - a trait shared by its near neighbor psychopathologies, antisocial personality disorder, and psychopathy. The association between narcissism and aggression is somewhat more complex. Both dimensions are associated with higher levels of aggression, but they remain differentiable. Grandiose and vulnerable narcissism are associated with higher rates of reactive aggression (acting aggressively following a perceived slight, threat, or aggression), but grandiose narcissism seems to have a stronger association with proactive aggression, which is more instrumental in nature (Vize, Collison,

Crowe, et al., 2019; Weiss et al., 2019). This divergence is in line with arguments that the grandiose and vulnerable expressions can be conceptualized as differing in approach vs. avoidance orientation. It is possible that behavioral differences are also present in the realm of reactive aggression. At least one study has suggested that while vulnerable individuals self-report high levels of reactive aggression, they do not exhibit higher levels of behavioral aggression or increased testosterone production in laboratory-based aggression paradigms (Lobbestael,

Baumeister, Fiebig, & Eckel, 2014). Grandiose individuals did not show the same report- behavior inconsistency (Lobbestael et al., 2014). Recent meta-analyses of grandiose narcissism in relation to aggression in general (Vize, Lynam, Collison, & Miller, 2018) and laboratory- based aggression (Hyatt, Zeichner, & Miller, in press) both suggest a small but meaningful link between the two (mean rs = .23 and .20, respectively).

Internalizing behavior. Emerging evidence suggests that neuroticism (i.e., negative Narcissism and Narcissistic Personality Disorder 23

emotionality) may represent a common factor underlying all internalizing disorders (Lahey,

2009). Recent analyses suggest roughly 65% of the variance in vulnerable narcissism can be accounted for by trait neuroticism and that their nomological networks are nearly identical

(Miller, Lynam, Vize, et al., 2018). It is therefore no surprise that vulnerable narcissism has a uniquely strong association with internalizing symptoms (e.g., anxiety, depression, rejection sensitivity, distrust) and disorders. In a recent examination of narcissism’s clinical correlates, vulnerable narcissism had substantial positive associations with measures of interpersonal guilt, pathological cognitive distortions, experiential avoidance, and life dissatisfaction (Kaufman et al., in press). Borderline personality disorder (BPD) also shares a pattern of correlates quite similar to that of vulnerable narcissism. When the two personality pathologies were correlated with general personality traits, etiological variables, and criterion variables, their nomological nets were nearly identical (r = .93; Miller, Widiger, et al., 2010).

Psychopathology. In recent years there has been a movement to develop an empirically based diagnostic system for psychopathology based on the covariance of clinical symptoms.

Within the Hierarchical Taxonomy of Psychopathology (HiTOP; Kotov et al., 2017), NPD is currently included in the “antagonistic externalizing” domain, but developers are continuing to try and clarify this location as empirical evidence of NPD’s psychopathological correlates and

“near neighbor” disorders is mixed with some indicating an association with internalizing disorders (e.g., anxiety, depression) and others indicating an association with externalizing disorders (e.g., aggression, psychopathy). The examination of grandiose and vulnerable narcissism has helped to clarify this conflict as it has become clear that narcissism’s primary psychopathological correlates are largely dependent on the means of assessing narcissistic traits and the extent to which it emphasizes grandiose or vulnerable expressions. Vulnerable Narcissism and Narcissistic Personality Disorder 24

narcissism is a distress-based disorder similar in nature to borderline personality disorder (Miller et al., 2017; Weiss & Miller, 2018) and its robust and largely non-discriminant correlations in this domain can be largely accounted for by its association with neuroticism (Miller, Lynam,

Vize, et al., 2018; Weiss et al., 2019). Grandiose narcissism is a far more distinct construct related to but distinguishable from other externalizing disorders (e.g., antisocial personality disorder, psychopathy).

A Unified Model of Narcissism

As noted throughout our discussion, heterogeneity within the narcissism construct has called for more nuanced and flexible models that differentiate between grandiose and vulnerable presentations. When conceptualized as a single dimension (i.e., NPD), narcissism includes both grandiose and vulnerable elements, with NPD criteria generally emphasizing narcissistic grandiosity (Fossati et al., 2005; Miller et al., 2008), while the DSM-5 text additionally includes references to emotional vulnerability (APA, 2013; Ackerman et al., 2017). The lack of a clear operational definition for the domain has led to many conflicting accounts of narcissism’s empirical profile that are only now starting to be resolved.

Calls for broad recognition of the two-factor structure of narcissism (i.e., grandiose vs. vulnerable) were necessary for the field to begin acknowledging and organizing the conflicting associations within the construct (and the highly variable assessment approaches). Although significant progress has been made since general acceptance of narcissism’s two-dimensional presentation, many controversies regarding narcissism’s theoretical boundaries and empirical correlates still remain (Miller et al., 2017). We believe many of these controversies have emerged as a result of the fields’ failure to develop an integrated model of the narcissism domain that can account for and unite the divergent expressions of grandiose and vulnerable narcissism Narcissism and Narcissistic Personality Disorder 25

under a single broader construct. Failure to develop a unified model would have at least two important implications. First, failure would be likely to result in the continuation of spurious demarcations (e.g., normal vs. pathological narcissism) intended to understand the diversity of narcissistic phenotypes. Second, if no unifying characteristics could be identified, it would be appropriate to regard grandiose and vulnerable presentations as separable phenotypes that cannot be accurately included under the same term.

The trifurcated model. Efforts to examine the viability of a unified model of narcissism has resulted in converging evidence from multiple research programs for a “trifurcated” (i.e., three-factor) model (Crowe et al., 2019; Krizan & Herlache, 2018; Miller, Lynam, McCain, et al., 2016; Weiss et al., 2019) in which more peripheral components of narcissism (i.e., those specific grandiose or vulnerable presentations) are separated from the “core” components of the construct (i.e., those common to both grandiose and vulnerable dimensions). The trifurcated model (Crowe et al., 2019; Miller, Lynam, McCain, et al., 2016) attempts to understand narcissism’s underlying structure through its association with general FFM personality traits.

Within this model, narcissism’s “core” is labeled Antagonism (or Self-centered Antagonism), and its components that distinguish between different narcissism presentations are identified as

Agentic Extraversion, and Narcissistic Neuroticism. The Narcissistic Spectrum Model (NSM;

Krizan, 2018; Krizan & Herlache, 2018), an independently developed integrative model, takes a functional orientation and identifies “entitled self-importance” as the core of narcissism while boldness/reward motivation and emotional reactivity/avoidance motivation serve as differentiating components. These three-factor models of narcissism (i.e., the trifurcated model, the NSM) are far from mutually exclusive. Similar factor analytic methods were utilized in the development of both models (Crowe et al., 2019; Krizan & Herlache, 2018; Miller, Lynam, Narcissism and Narcissistic Personality Disorder 26

McCain, et al., 2016) and we believe these are, essentially, congruent models with differences generally limited to how broadly or narrowly the dimensions are defined, as well as the names given to each of the three components.

Separating narcissism into these three components has a number of benefits beyond the two-dimensional organization. Utilizing broad multidimensional domains as primary criteria of interest makes interpretation of correlates and theory development difficult (Smith, McCarthy, &

Zapolski, 2009). A heterogeneous combination of traits within grandiose and vulnerable narcissism makes understanding their nomological nets an ambiguous process as any correlations may vary in magnitude across lower-order constructs. Separating narcissism into three more homogeneous domains allows for greater precision of measurement and can, as a result, provide clarity to the elements driving grandiose and vulnerable narcissism’s shared and unshared correlates. Generally speaking, antagonism, as the shared domain, seems to be the binding factor that accounts for grandiose and vulnerable narcissism’s shared association with a range of interpersonal pathologies including antisocial behavior, aggression, and psychopathy (Vize,

Collison, Crowe, et al., 2019; Vize, Collison, & Lynam, in press; Weiss et al., 2019). Agentic

Extraversion and Narcissistic Neuroticism, on the other hand, seem to be relatively unique to the different phenotypic expressions. Miller and colleagues (2017) point out that “neuroticism and extraversion serve to distinguish or drive apart grandiose and vulnerable narcissism” (p. 296). In this sense, they can be conceptualized somewhat as “diagnostic specifiers” of narcissistic expression. Agentic extraversion seems to account for the “adaptive” correlates unique to grandiosity, and narcissistic neuroticism seems to be the driving force behind its unique association with negative emotionality and other mood disorders. This is broadly consistent with

Krizan and Herlache’s (2018) argument that the peripheral components emerge from differences Narcissism and Narcissistic Personality Disorder 27

in approach (i.e., agentic extraversion) and avoidance (i.e., neuroticism) orientation.

Grandiose narcissism is sometimes referred to as “adaptive” narcissism due to its negative association with measures of subjective distress (Pincus & Lukowitsky, 2010). While we disagree with this characterization, it is true that grandiose narcissism is more of a “mixed blessing.” The construct has negative associations with DSM-5 pathological traits negative affectivity and detachment (Weiss et al., 2019), is inversely related to maladaptive (i.e., avoidant) attachment (Kaufman et al., in press), and is positively related to self-esteem (Crowe et al., 2019; Miller, Lynam, McCain, et al., 2016), life satisfaction, personal growth and self- acceptance (Kaufman et al., in press). The trifurcated model provides clarification. Miller and colleagues (2016) demonstrated that where antagonism is unrelated to self-esteem, agentic extraversion and neuroticism have opposing relations with the construct (i.e., r = .35 and r = -

.36, respectively). Measures of grandiose and vulnerable narcissism therefore diverge in their association with self-esteem due to these components. Agentic extraversion’s association with self-esteem is most likely a driving force behind these beneficial outcomes (Hyatt, Sleep,

Lamkin, et al., 2018). The three-factor model also allows for clarification of narcissism’s association with interpersonal styles as measured by the interpersonal circumplex (i.e., dominance and love; Wiggins, 1995). Agentic extraversion and narcissistic neuroticism determine narcissism’s location on the dominance axis with positive (r = .54) and negative (r = -

.30) associations respectively (Weiss et al., 2019). Antagonism is unrelated to interpersonal dominance, but it accounts for grandiose and vulnerable narcissism’s shared association with love (i.e., Antagonism r = -.70, Agentic Extraversion r = .11, Neuroticism r = -.03; Weiss et al.,

2019). Put simply, the three-factor model allows for greater understanding of both the divergence and convergence of grandiose and vulnerable correlates. Where the different presentations Narcissism and Narcissistic Personality Disorder 28

converge, the relation is likely attributable to antagonism. Where they diverge, it is the result of narcissism’s differentiating components (i.e., agentic extraversion, neuroticism).

The “core” of narcissism. There is converging evidence that antagonism (i.e., low agreeableness), or aspects thereof (i.e., entitlement) are central to the narcissism domain. The trifurcated model argues that antagonistic interpersonal tendencies represent the “core” that is common to both grandiose and vulnerable narcissism and the glue that binds narcissism to other aversive constructs including the Dark Triad (Paulhus & Williams, 2002; Vize, Collison, Miller,

& Lynam, 2019) and Cluster B PDs. Nearly all DSM-5 diagnostic criteria for NPD (e.g., arrogance, exploitative, lack of empathy, entitlement) are related to facets of the agreeableness domain (APA, 2013). Agreeableness is the only FFM domain that consistently shows strong

(negative) associations with both grandiose and vulnerable expressions (see Table 1).

The centrality of antagonism to narcissism is further supported by a recent “Bass- ackward” (Goldberg, 2006) exploration of narcissism’s structure. Goldberg’s bass-ackward approach calls for extraction of an increasing number of factors from a domain while saving factor scores at each level of extraction. Factor scores are then correlated to yield a “hierarchy” of the domain (see Figure 1). This process was used to understand narcissism in an analysis that included 303 narcissism-related items from 46 scales and sub-scales (Crowe et al., 2019). The resulting hierarchy shows that narcissism (as defined by the total content of the scales) can be divided into two correlated factors (i.e., grandiose and vulnerable). At the third level, grandiose and vulnerable narcissism each yield a unique subfactor (i.e., Agentic Extraversion, Narcissistic

Neuroticism) while sharing a near equal association with a common factor characterized by exploitative, and combative interpersonal beliefs and tendencies (i.e., Self-centered Antagonism;

Crowe et al., 2019). Narcissism and Narcissistic Personality Disorder 29

Unlike the trifurcated model, which attempts to understand narcissism from its common personality correlates, the Narcissistic Spectrum Model (NSM; Krizan and Herlache, 2018) attempts to understand the transactional processes (i.e., functional interplay between individuals and their environment; see Wood, Gardner, & Harms, 2015; Wood, Spain, & Harms, 2017) underlying the two narcissistic dimensions. It identifies entitled self-importance (i.e., “a sense of oneself and one’s needs being special and more important than others”) as the core of narcissistic psychopathology (p. 16, Krizan, 2018). Entitlement is characterized by feelings of deservingness, specialness, and exaggerated expectations of others (Campbell, Bonacci, et al., 2004; Grubbs &

Exline, 2016), and findings consistently show that entitled attitudes are an attribute shared by both grandiose and vulnerable expressions (Brown, Budzek, & Tamborski, 2009; Campbell,

Bonacci, et al., 2004; Crowe, LoPilato, Campbell, & Miller, 2015; Fossati et al., 2005; Grubbs &

Exline, 2016; Krizan & Herlache, 2018; Miller, Hoffman, et al., 2011). Entitlement is also directly recognized as integral to NPD within the DSM-5 diagnostic criteria, and surveys of clinicians and researchers suggest that entitlement is characteristic of both grandiose and vulnerable expressions (Ackerman et al., 2017; Russ, Shedler, Bradley, & Westen, 2008). The

NSM offers hypotheses regarding the functional processes that yield grandiose and vulnerable expressions within a dynamic inter- and intra-personal system. Krizan (2018) specifically identifies entitled self-importance as a mechanism through which other antagonistic behaviors emerge. In this way, the NSM is in line with arguments for the need to understand personality as a dynamic process (e.g., Fleeson & Jayawickreme, 2015). The Narcissistic Admiration and

Rivalry Concept (NARC; Back, 2018; Back et al., 2013) is similar to the NSM in that it attempts to account for grandiose narcissism using a dynamic (i.e., cognitive-affective-motivational) model. The NARC’s dimensions of Admiration and Rivalry appear to map well onto the Narcissism and Narcissistic Personality Disorder 30

trifurcated model’s Agentic Extraversion and Self-centered Antagonism dimensions respectively.

There may be benefits associated with having a more narrowly defined “core” to the domain, as suggested by the NSM. As a relatively specific and homogeneous construct, entitlement could allow for more discriminant validity between narcissism and other antagonism- based disorders. However, it may be difficult to effectively separate entitled attitudes from their broader personality correlates. Entitlement failed to emerge as a specific factor in Crowe and colleagues (2019) structural analysis of narcissism even after the item pool was limited to only the most narcissism-specific items. This does not exclude the possibility that entitled self- importance, as suggested by Krizan and Herlache (2018), represents a functional process central to the narcissism domain. It does however suggest that if true, that functional process either yields or co-occurs with a range of other antagonistic behaviors and attitudes, making them indistinguishable in cross-sectional analyses. Understanding antagonism, a broader construct, as core to the narcissistic domain is consistent with the nature of trait covariation. As a superordinate dimension of personality, agreeableness represents a collection of personality traits that naturally co-occur. It is, for example, hard to imagine a highly exploitative individual who is not also callous. This is not to indicate that all facets of antagonism are equally relevant to both narcissism presentations. Agreeableness is itself a multifaceted construct (Crowe, Lynam, &

Miller, 2018) consisting of traits that appear to have differential relations to grandiose and vulnerable expressions (see Table 1).

Narcissism and the Oscillation Hypothesis

The state-level of stability of narcissism is a second (the first being development of a unifying structural model) topic of great interest within the field and it remains a hotly contested issue. It has been suggested that an entirely trait-based conceptualization of narcissism disregards Narcissism and Narcissistic Personality Disorder 31

the possibility of fluctuations in narcissistic states and self-esteem, which some argue is a definitional feature of narcissism (e.g., Pincus & Lukowitsky, 2010). It has similarly been suggested that both grandiose and vulnerable narcissism share a common etiology: the need for validation as a means of maintaining a positive self-image which can result in both seeking out self-enhancement (grandiose) and emotional dysregulation (vulnerable) when the need for validation is not fulfilled (Pincus et al., 2009; Ronningstam, 2010). Such a conceptualization suggests that narcissistic individuals oscillate between grandiose and vulnerable states depending on their current level of self-enhancement success and the presence of ego threats in the environment. Focus on between-person dimensions (e.g., grandiose vs. vulnerable) of narcissism and the prevalence of cross-sectional designs has thus far made direct evaluation of the oscillation hypothesis difficult.

The extent to which individuals fluctuate in their expression of narcissistic dimensions is a hotly debated issue which requires significantly more research (Wright & Edershile, 2018).

Existing data suggest that narcissism-related traits are relatively stable (Giacomin & Jordan,

2015; Wright & Simms, 2016). Cross-sectional evidence tends to indicate that narcissistically grandiose individuals may experience aspects of vulnerability, particularly anger, in response to ego threats (Gore & Widiger, 2016; Hyatt et al., 2018), but there is little evidence to suggest that narcissistically vulnerable individuals experience periods of grandiosity. The few longitudinal findings that exist are mixed. Findings have generally not indicated higher mean levels of vulnerable features such as negative affect among grandiosely narcissistic individuals

(Rhodewalt, Madrian, & Cheney, 1998; Zuckerman & O’Loughlin, 2009; cf. Emmons, 1987).

Grandiose narcissism has been linked to greater reactivity of self-esteem to negative interpersonal events (Rhodewalt, Madrian, & Cheney, 1998; Zuckerman & O’Loughlin, 2009) Narcissism and Narcissistic Personality Disorder 32

and a higher proportion of negative interpersonal interactions (Rhodewalt et al., 1998). However, previous studies on the subject have been generally limited by their methods of analysis.

Emerging measures will soon allow for more direct assessment of the oscillation hypothesis. The recently developed FLUX scales (Oltmanns & Widiger, 2018) are one such measure. Following evidence that cross-sectional self-report measures can capture significant variance in within-person variability across time (Webster, Smith, Brunell, Paddock, & Nezlek,

2017), the FLUX scales were developed for the specific purpose of measuring fluctuations between grandiose and vulnerable narcissism. Initial evidence is promising as its three scales of narcissistic fluctuation (i.e., indifference/anger, grandiosity/shame, assertiveness/insecurity) show a pattern of association with criterion variables in line with theoretical expectations

(Oltmanns & Widiger, 2018). A potential strength of the FLUX measures is its ability to capture narcissistic instability without necessitating the collection of expensive Ecological Momentary

Assessment (EMA; i.e., real time repeated measures of participant behaviors and feelings) data.

However, further validation of the FLUX scales is necessary and EMA approaches remain the gold standard for evaluating the fluctuation hypothesis. With scales designed for such procedures now validated, such studies are underway. The first EMA analyses using state-validated narcissism measures provided mixed findings (Edershile & Wright, in press). Edershile and

Wright used the Narcissistic Grandiosity Scale (NGS; Crowe et al., 2016; Edershile et al., in press) and Narcissistic Vulnerability Scale (NVS; Crowe, Edershile, et al., 2018; Edershile et al., in press) to collect more than 32,000 momentary assessment data observations from three unique samples. In line with previous cross-sectional analyses (i.e., Gore & Widiger, 2016; Hyatt et al.,

2018) they observe that grandiosely narcissistic individuals seem to experience both grandiose and vulnerable states while vulnerable individuals are unlikely to experience grandiose states. Narcissism and Narcissistic Personality Disorder 33

Use of the trifurcated model provided further clarity to their findings. When grandiose and vulnerable narcissistic states were predicted from the trifurcated model, only antagonism was positively associated with the experience of both grandiose and vulnerable narcissistic states

(Edershile & Wright, in press). This suggests that the extent to which grandiose individuals experience both grandiose and vulnerable states may be a result of their shared association with antagonism (Edershile & Wright, in press). These results provide further support for both the centrality of antagonism to the narcissism domain, and the importance of measuring all dimensions of the trifurcated model.

The oscillation hypothesis remains part of an open debate. Current evidence is limited and EMA studies to date have lasted no more than two weeks. If narcissistic fluctuation does occur, it may be difficult to find over relatively brief periods of time. In this sense, cross- sectional measures provide value as they cover more extended periods of time and are thereby more likely to capture major events within a person’s life. Additional multi-method research

(e.g., EMA, cross-sectional, longitudinal) is necessary to conclude that oscillation does or does not occur. Beyond that, additional research is needed to understand the cognitive/motivational mechanisms of fluctuation, if it does occur. Some clinical theorists argue that hidden shame and a fragile self-esteem drive fluctuation in presentation (Pincus & Lukowitsky, 2010;

Ronningstam, 2009). Those conclusions seem premature given the state of the literature. There is emerging evidence that grandiose individuals are reactive to potential ego threats (Gore &

Widiger, 2016; Hyatt et al., 2018). Whether that reactivity is motivated by insecurity or other factors is currently unclear.

Measuring Narcissism

In view of growing consensus about narcissism’s trifurcated structure, it is important to Narcissism and Narcissistic Personality Disorder 34

review the availability of assessment tools that capture narcissism’s three levels of complexity.

Although interview-based diagnostic assessments of NPD do exist (First, Williams, Benjamin, &

Spitzer, 2016), the vast majority of narcissism research relies on self-report measures. The increased recognition of the multidimensional nature of narcissism as well as increases in clinical and academic interest has resulted in an explosion of measurement tools, each conceptualizing the construct in its own way. Integrated structural models allow for the synthesis of research by capturing the commonalities of existing systems (John, Naumann, & Soto, 2008). The trifurcated model therefore not only allows for a more precise understanding of narcissism’s nomological network, but also provides a parsimonious organizational system for the full range of narcissism self-report measures (see Figure 2 and Table 2). The results reported in Table 2 were generated by Crowe and colleagues (2019) following the “Bass-ackwards” analysis. It shows the correlations between the factor scores derived from the first three steps of the analysis and a range of narcissism scales and subscales. Most individual measures capture only a subset of the total narcissism domain. Scale selection decisions should therefore be made in parallel to decisions regarding the level of analysis one is most interest in capturing with the understanding that in most cases the more precise measurement is preferred (Smith et al., 2009). Measurement of narcissism as a one-dimensional construct is not recommended given the divergent nomological nets of grandiose and vulnerable narcissism and associated risks of suppression effects. Additional considerations will necessarily include study design (e.g., cross-sectional, repeated measures) and affiliated practical limitations (e.g., item count limitations).

Multidimensional narcissism measures. Few single narcissism measures can effectively capture the narcissism domain with enough breadth to accurately represent narcissism as a single dimension. The Five Factor Narcissism Inventory (FFNI; Glover, Miller, Lynam, Narcissism and Narcissistic Personality Disorder 35

Crego, & Widiger, 2012) and Pathological Narcissism Inventory (PNI; Pincus et al., 2009) are the most commonly utilized comprehensive measures. The Narcissistic Admiration and Rivalry

Questionnaire (NARQ; Back et al., 2013) is another commonly used multidimensional measure, but it is limited to coverage of the grandiose dimension (see Figure 2).

Five-Factor Narcissism Inventory (FFNI). The FFNI was developed following expert survey and empirical review of the FFM traits most relevant to grandiose and vulnerable narcissism (Glover et al., 2012; see Crowe & Miller, 2017 for full review of development and empirical support). The review process identified facets from all five personality domains which are represented in the 15 facet-level scales of the FFNI. The full FFNI is 148-items, but a brief

(i.e., 60-item) version has been developed and validated (Sherman et al., 2015). Individually, the

FFNI’s 15 facet-level scales are among the most narrowly defined narcissism facets, and together they appear to provide the most comprehensive coverage of the narcissism domain (see Figure

2). As a result, the FFNI may be the best single measure for capturing both the 2-(i.e., grandiosity vs. vulnerability; Miller et al., 2014) and 3-factor levels (i.e., self-centered antagonism, agentic extraversion, and narcissistic neuroticism; Crowe et al., 2019). An informant-report version of the FFNI (IFFNI; Oltmanns, Crego, & Widiger, 2018) was also recently validated.

Pathological Narcissism Inventory (PNI). The PNI is the other commonly used multidimensional self-report narcissism measure. It was developed to capture “pathological narcissism” and its item development was based on both a literature review and consideration of case presentations from psychotherapists working with individuals with narcissistic personality traits (Pincus et al., 2009). As a result of this approach, the PNI emphasizes aspects of emotional vulnerability more so than the FFNI (Miller et al., 2014; Thomas, Wright, Lukowitsky, Narcissism and Narcissistic Personality Disorder 36

Donnellan, & Hopwood, 2012). Relatedly, the PNI’s grandiose narcissism construct tends to deviate from other measures of grandiose narcissism (and expert conceptualizations; see Miller

& Lynam, 2017 for a review) in its relatively higher association with a broad set of pathological personality traits (Miller, Lynam, & Campbell, 2016a) and vulnerable narcissism. The extent to which this represents a criterion problem has been the subject of debate (Miller, Lynam, &

Campbell, 2016a, 2016b; Wright, 2016). We have argued that criterion comparisons suggest that the PNI’s coverage of the grandiose dimension is problematically limited (see Miller & Lynam,

2017 for a review). More recent analyses have shown that partialing narcissistic vulnerability from the PNI’s measure of narcissistic grandiosity yields a nomological network more consistent with expectations (Edershile, Simms, & Wright, 2018), but this process has its own drawbacks

(Lynam, Hoyle, & Newman, 2006; Sleep, Lynam, Hyatt, & Miller, 2017).

Narcissistic Admiration and Rivalry Questionnaire (NARQ). The NARQ (Back et al.,

2013) is a multidimensional 18-item measure, but like the PNI, it does not provide coverage of the full trifurcated structure. The NARQ was developed alongside a dynamic process model of grandiose narcissism, the Narcissistic Admiration and Rivalry Concept (NARC). The NARC identifies maintenance of the grandiose sense of self as the primary motivating factor among narcissistic individuals and proposes that they achieve this goal through the use of two separate sets of social strategies labeled narcissistic admiration (i.e., assertive self-enhancement strategies) and narcissistic rivalry (i.e., antagonistic self-protection strategies). Empirical support has been found for the NARQ’s proposed factor structure (Back et al., 2013) as well as for its proposed interpersonal processes (Grove, Smith, Girard, & Wright, 2019). When mapped onto the trifurcated model the NARQ’s admiration and rivalry dimensions coincide with agentic extraversion and antagonism, respectively (Crowe et al., 2019). Narcissism and Narcissistic Personality Disorder 37

Self-report measures of NPD. A structured diagnostic interview of DSM-5 NPD criteria is the gold standard for NPD assessment. However, self-report measures of DSM personality disorders are commonly applied in clinical and research contexts. Two such measures, the

Personality Diagnostic Questionnaire 4+ (PDQ-4+; Hyler, 1994) and the Structured Clinical

Interview for DSM-IV personality disorders questionnaire (SCID-II; First, M. B., Gibbon, M.,

Spitzer, R. L., Williams, J. B., & Benjamin, L. S., 1997) are reviewed here. These are not the only self-report NPD assessments either validated or derived using DSM diagnostic criteria (see

Watson & Bagby, 2012 for a more comprehensive review).2

Personality Diagnostic Questionnaire 4+ (PDQ-4+). The PDQ-4+ (Hyler, 1994) is likely the most commonly applied self-report assessment of personality disorders. The NPD scale of the PDQ-4+ is composed of nine true/false items that directly correspond to the nine

DSM diagnostic criteria for NPD. For example, for the interpersonally exploitative diagnostic criterion, the PDQ-4+ includes the item: “some people think that I take advantage of others”

(Hyler, 1994). While the measure is face valid, a number of concerns have been raised due to the measure’s relatively weak association with expert- and clinician-rated NPD prototypes (Miller &

Campbell, 2008). Miller and Campbell (2008) point out that the inconsistency seems to emerge due to the measure’s its tendency to capture a more emotionally unstable and negative affect- laden construct. Relatedly, there seems to be only a moderate association between the PDQ-4+

NPD total score and clinical assessment ratings of NPD (Miller, Campbell, Pilkonis, & Morse,

2 It may have also been appropriate to consider in this section the NPI, which used the DSM-III NPD diagnostic criteria as a “conceptual template” (Raskin & Terry, 1988, p. 892) for its item pool, and the PID-5, which is the primary self-report measure for the DSM-5 Section III model for personality disorders. However, both measures are discussed in detail elsewhere in the manuscript. Narcissism and Narcissistic Personality Disorder 38

2008). Based on its correlation profile, it seems accurate to characterize the PDQ-4 NPD scale as capturing aspects of both grandiose and vulnerable narcissism or including all three elements of the trifurcated model.

Structured Clinical Interview for DSM-IV Personality Disorder Screening

Questionnaire (SCID-II PD SQ). The SCID-II Personality Disorder Screening Questionnaire

(First et a., 1997) is a 119-item self-report questionnaire developed to accompany the structured clinical interview for personality disorders in the DSM-IV. The questionnaire contains 17 yes/no items keyed to the nine NPD diagnostic criteria (e.g., “Do people often fail to appreciate your very special talents or accomplishments?”). Like the PDQ-4, the SCID-II NPD screening questionnaire seems to include both grandiose and vulnerable content in its total score (See Table

2).

Measures of grandiose narcissism. As shown in Figure 2, the majority of narcissism measures emphasize grandiose narcissism content.

Narcissistic Personality Inventory (NPI). The NPI has long been the most prominent measure of grandiose narcissism. Introduced in 1979 by Raskin and Hall, its modern 40-item form was published nearly a decade later (Raskin & Terry, 1988). The NPI is somewhat unique among modern personality measures due to its forced-choice format. That is, rather than rate agreement with individual items on a Likert-type response scale, the original NPI requires responders to read item pairs and select one item from each pair that best represents their own feelings and beliefs. Despite its long history of use, the NPI has been the subject of considerable criticism for its content (Rosenthal & Hooley, 2010), response format (Ackerman, Donnellan,

Roberts, & Fraley, 2016), unstable factor structure (Foster, McCain, Hibberts, Brunell, &

Johnson, 2015) and poor internal consistency (Ackerman et al., 2011). A range of modifications Narcissism and Narcissistic Personality Disorder 39

of the scale have been proposed to address these concerns and others. There is some evidence to indicate that modification of the NPI to a Likert response format may result in improved subscale reliability without meaningfully modifying the measured construct (Ackerman et al., 2018;

Miller, Gentile, Carter, et al., 2018). While the original seven-factor structure of the scale is not easily replicable, more recent analyses have shown that a subset of the 40 items yields a stable three-factor structure: Leadership/Authority, Grandiose Exhibitionism,

Entitlement/Exploitativeness (Ackerman et al., 2011). Abbreviated (i.e., 16-item: Ames, Rose, &

Anderson, 2006; 13-item: Gentile et al., 2013) versions of the scale have also been validated.

However, these modifications do not address more fundamental concerns that have been expressed regarding the NPI’s construct validity (Rosenthal & Hooley, 2010; Rosenthal,

Montoya, Ridings, Rieck, & Hooley, 2011; see also Miller, Maples, & Campbell, 2011). Critics of the measure argue that the construct measured by the NPI over-emphasizes adaptive elements

(e.g., leadership/authority) at the cost of more pathological components. While the NPI was originally developed to measure narcissism in the general population, its relationship with general personality and psychopathological constructs are consistent with grandiose narcissism and NPD more generally (Miller, Gaughan, Pryor, Kamen, & Campbell, 2009; Miller et al.,

2014). Furthermore, in a recent integrative analysis of narcissism, the Likert-version of the NPI had a full-scale score that was among the most representative of grandiose narcissism (Crowe et al., 2019). Arguments that it measures “normal narcissism” are therefore difficult to defend, especially given its links to interview-based measures of NPD and psychopathy (Krusemark et al., 2018).

Grandiose Narcissism Scale (GNS). The GNS (Foster et al., 2015) was recently developed as an alternative to the NPI that attempted to address the NPI’s psychometric Narcissism and Narcissistic Personality Disorder 40

limitations (i.e., subscale unreliability, unstable factor structure) without meaningfully modifying the construct. The scale’s 33 items were specifically developed to capture the seven NPI factors originally proposed by Raskin and Terry (1988). Initial evaluations suggest that the GNS has internally consistent subscale scores (Crowe et al., 2019; Foster et al., 2015), which allow for examination of grandiose narcissism at the facet level.

Narcissistic Grandiosity Scale (NGS). The NGS (Rosenthal, Hooley, & Steshenko,

2007) is a 16-item measure intended to capture narcissistic grandiosity without confounding the construct with self-esteem. The NGS is unique due to its adjective-based items which require responders to rate the extent to which they feel “superior” and “dominant” among others. The strength of such a design is that adjective descriptors can be considered for nearly any time scale.

By adapting the instructions to encourage responders to consider how they feel on average or at a particular moment, the scale can reasonably be used as a trait- or state-based measure. A briefer

(6-item) version of the scale was developed specifically to capitalize on the NGS’s flexibility in this regard (Crowe, Carter, Campbell, & Miller, 2016). Recent evaluations of the NGS have shown that the measure is effective at capturing grandiose narcissism at the trait level (Crowe et al., 2019) and that the brief version is a valid measure of narcissistic grandiosity for use in ecological momentary assessment (EMA) designs (Edershile et al., in press).

Dark Triad Measures of Narcissism. There is a growing body of research on the “Dark

Triad” (DT) of personality traits (Paulhus & Williams, 2002). In their seminal work, Paulhus and

Williams (2002) advocated for the simultaneous study of psychopathy, narcissism, and

Machiavellianism with the goal of examining the ways in which the three antagonistic personality constructs overlap and diverge. From this body of research, emerged two measures that attempt to capture all three constructs, the Short Dark Triad (SD3; Jones & Paulhus, 2014) Narcissism and Narcissistic Personality Disorder 41

and the Dirty Dozen (DD; Jonason & Webster, 2010). Both measures conceptualize narcissism as a single dimension, but the scales do not converge. In a direct comparison of the two measures, it was shown that the SD3 seems to capture a construct generally consistent with the

NPI total score while the DD narcissism score reflects a combination of grandiose and vulnerable expressions (Maples, Lamkin, & Miller, 2014). While brief, these DT scales are limited by their unidimensional characterization of narcissism. Excessive use of unidimensional conceptualizations of multidimensional constructs is one of several features of much of the DT literature that has sparked criticism of late (Miller, Vize, Crowe, & Lynam, 2019).

Measures of vulnerable narcissism. Compared to grandiose narcissism, there is a relative dearth of narcissistic vulnerability measures, likely because the widespread recognition of vulnerable narcissism is a relatively recent occurrence.

Hypersensitive Narcissism Scale (HSNS). The HSNS (Hendin & Cheek, 1997) was the first scale specifically intended to measure narcissistic vulnerability. It was developed following

Wink’s (1991) seminal paper explicitly identifying the grandiose and vulnerable narcissism dimensions. Prior to the HSNS, vulnerable or “covert” narcissistic expressions were captured using MMPI-based scales developed using a criterion keying approach. Hendin and Cheek

(1997) developed the HSNS by correlating items from a previous narcissism scale (Murray,

1938) with a composite of the “covert” narcissism dimension identified by Wink (1991). Outside of the multidimensional narcissism measures (i.e., FFNI, PNI), the HSNS is nearly the only measure of vulnerable narcissism currently seeing regular use. Two principal components of the

HSNS (i.e., Oversensitivity to Judgement, Egocentrism) have been identified (Fossati et al.,

2009) but are rarely utilized in practice; however, it is noteworthy as the two components’ item content suggest a reasonable overlap with vulnerable narcissism as conceptualized by the Narcissism and Narcissistic Personality Disorder 42

trifurcated model (i.e., oversensitivity to judgement – neuroticism; egocentrism – antagonism).

Narcissistic Vulnerability Scale (NVS). The NVS (Crowe, Edershile, et al., 2018), not to be confused with the vulnerable narcissism scale developed by Bachar and colleagues (2005)3, was developed as the vulnerable counterpart to the NGS. Like the NGS, the NVS is an adjective- based measure written to allow for both trait and state-based assessment. Items were selected through a process of expert ratings. Initial factor analyses suggest that it is an internally consistent unidimensional measure at both the between and within-person levels (Crowe,

Edershile, et al., 2018). Validity assessments have shown that it maintains a nomological network consistent with theoretical expectations at both the between and within-person level

(Crowe, Edershile, et al., 2018; Edershile et al., in press).

The measurement “stack” approach. While only the FFNI can effectively account for all three dimensions of the trifurcated model, numerous measures can account for one or more of the three dimensions. Some researchers have therefore begun advocating for a measurement

“stack” approach (Brunell & Buelow, 2018; Crowe et al., 2019; Weiss et al., 2019). This approach utilizes the combination of multiple assessment instruments which together can account for the full domain. For example, the HSNS and NARQ (a total of 28 items combined) may effectively capture the breadth of the narcissism domain (see Figure 2). An earlier argument for this approach was made by Brown and colleagues (2009) who pointed towards problems arising from research reliant on the NPI total score due to its tendency to obscure divergent relations between lower-order traits (i.e., assertiveness, antagonism) and problematic outcomes.

3 Bachar and colleagues’ (2005) NVS was developed specifically for the purpose of a study evaluating the relations between narcissistic traits and the development of Posttraumatic Stress Disorder. It has been utilized on a number of occasions for similar research, but its use in the broader narcissism literature is rare. Narcissism and Narcissistic Personality Disorder 43

As an alternative, they proposed the use of narrowly defined homogeneous scales intended to capture the most important facets of the construct - specifically the NGS and the Psychological

Entitlement Scale (Campbell, Bonacci, et al., 2004). This approach fits well into the trifurcated model as the NGS and PES may be reasonable proxies for agentic extraversion and antagonism respectively, but the specific proposal made by Brown and colleagues (2009) over-emphasized specificity at the cost of content coverage (Miller, Price, & Campbell, 2012).

If utilizing a measurement stack approach, researchers should take care to ensure sufficient coverage of the domain. Two recent advancements in the literature may guide this process of scale selection. First, the convergence within the field onto an integrated three-factor structure suggests that there is an emerging consensus regarding what constitutes “complete” coverage of the construct (Krizan & Herlache, 2018; Miller et al., 2017; Miller, Lynam, McCain, et al., 2016; Wright & Edershile, 2018). Second, initial analyses mapping a broad range of narcissism scales onto this consensual structure have been completed (Crowe et al., 2019). This

“map” of narcissism measures (see Figure 2) may function as a guide for scale selection. A

“choose your own adventure” approach to measuring narcissism may allow greater flexibility to identify facets of greatest interest and emphasize scales that capture those facets with greatest precision. It could also allow for briefer assessment batteries. For example, if space is too limited for the (60-item) FFNI-SF, the bulk of the construct can likely be captured with the combination of the NARQ (18 items) and the FFNI-V (16 items).

Conclusions

Research on narcissism is thriving with an increase in popular interest as well as sophistication of research methods. During the long history of narcissism research, a number of controversies have been identified. The introduction of the grandiose and vulnerable dimensions Narcissism and Narcissistic Personality Disorder 44

to the literature (as opposed to a one-factor conceptualization of NPD/pathological narcissism) has allowed for resolution of many of these controversies, but many still remain. Grandiose narcissism represents the prototypical manifestation of the construct, while vulnerable narcissism is the presentation more commonly observed in clinical settings. Both of these manifestations may be conceptualized as pathological to the extent that they are pervasive and yield functional impairment, but the form of impairment (i.e., externalizing vs. internalizing) is inconsistent across them. We believe that general application of newly developed three-factor models of narcissism will provide the next major step for the field. Current evidence suggests that the trifurcated model allows for an integrated understanding of both grandiose and vulnerable narcissism and clarifies the shared and unshared associations among the dimensions. Converging evidence suggests antagonism, and a sense of self-importance, is the “core” of narcissism while agentic extraversion/boldness and emotional vulnerability/reactivity can be understood as dimension-specific components. Future research attempting to understand the etiology and stability of narcissism should incorporate this model by adopting assessment methods that can effectively separate narcissism into its component parts.

Narcissism and Narcissistic Personality Disorder 45

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Table 1

Narcissism and the Five Factor Model

Academic Clinician Lay NPD GN VN Nar* GN* VN* AE* SA* NN* Profile Profile Person MA MA MA

Neuroticism Anxiety 2.33 2.71 2.39 0.02 0.03 0.41 0.04 -0.23 0.52 -0.22 0.09 0.60 Angry Hostility 4.08 3.90 3.56 0.23 0.25 0.45 0.24 0.05 0.49 0.01 0.34 0.44 Depression 2.42 2.75 2.75 0.03 0.00 0.57 0.01 -0.27 0.52 -0.27 0.10 0.59 Self-consciousness 1.50 1.67 1.83 -0.03 -0.11 0.54 -0.10 -0.37 0.42 -0.38 0.04 0.50 Impulsiveness 3.17 3.57 3.48 0.14 0.13 0.30 0.13 -0.05 0.40 -0.05 0.15 0.42 Vulnerability 2.92 2.76 2.38 -0.01 -0.06 0.45 0.00 -0.26 0.47 -0.29 0.15 0.50

Extraversion Warmth 1.42 2.05 2.16 -0.07 -0.02 -0.24 0.14 0.33 -0.25 0.41 -0.15 -0.21 Gregariousness 3.83 3.95 3.75 0.04 0.13 -0.17 0.28 0.41 -0.05 0.44 0.07 -0.07 Assertiveness 4.67 4.00 4.32 0.19 0.24 -0.25 0.35 0.54 -0.13 0.60 0.04 -0.15 Activity 3.67 4.14 3.96 0.09 0.14 -0.13 0.18 0.33 -0.15 0.38 -0.04 -0.15 Excitement Seek 4.17 4.10 3.89 0.16 0.16 -0.02 0.36 0.40 0.13 0.44 0.16 0.10 Positive Emotions 3.33 3.52 3.53 -0.02 -0.05 -0.24 0.12 0.32 -0.28 0.40 -0.18 -0.24

Openness Fantasy 3.75 3.82 3.56 0.11 0.08 0.09 0.15 0.10 0.18 0.17 -0.02 0.25 Aesthetics 3.25 3.32 3.56 0.04 0.00 0.04 -0.04 0.01 -0.11 0.09 -0.23 -0.01 Feelings 1.92 2.68 2.92 0.05 0.03 0.11 -0.02 -0.16 0.24 -0.08 -0.14 0.38 Actions 4.08 3.36 3.18 0.04 0.05 -0.16 0.04 0.17 -0.21 0.18 -0.04 -0.23 Ideas 2.92 3.09 3.17 0.07 0.08 -0.03 0.00 0.07 -0.13 0.13 -0.15 -0.08 Values 2.67 2.68 2.71 -0.01 0.02 -0.02 0.00 -0.03 0.06 -0.05 0.06 0.04

Agreeableness Trust 1.42 1.86 2.09 -0.20 -0.15 -0.38 -0.14 -0.03 -0.28 0.05 -0.29 -0.19 Straightforwardness 1.83 1.91 1.98 -0.31 -0.33 -0.18 -0.62 -0.53 -0.52 -0.45 -0.63 -0.36 Altruism 1.00 1.73 1.77 -0.20 -0.19 -0.18 -0.17 -0.05 -0.33 0.13 -0.56 -0.11 Compliance 1.58 1.77 1.98 -0.26 -0.27 -0.18 -0.49 -0.39 -0.47 -0.30 -0.57 -0.31 Modesty 1.08 1.23 1.55 -0.37 -0.37 -0.10 -0.62 -0.73 -0.18 -0.69 -0.48 -0.02 Tendermindedness 1.50 1.77 2.00 -0.17 -0.18 -0.10 -0.25 -0.23 -0.18 -0.08 -0.51 0.04

Conscientiousness Competence 3.25 3.00 3.50 0.01 0.06 -0.19 0.11 0.32 -0.30 0.39 -0.15 -0.27 Order 2.92 3.00 3.52 -0.03 -0.05 -0.03 -0.09 0.01 -0.22 0.06 -0.20 -0.18 Dutifulness 2.42 2.50 2.75 -0.10 -0.09 -0.15 -0.34 -0.18 -0.47 -0.07 -0.53 -0.33 Achievement 3.92 3.18 3.54 0.02 0.07 -0.12 0.15 0.30 -0.18 0.39 -0.14 -0.13 Self-discipline 2.08 2.23 2.83 -0.09 -0.03 -0.28 -0.11 0.10 -0.44 0.13 -0.22 -0.44 Deliberation 2.25 2.45 2.63 -0.13 -0.10 -0.09 -0.29 -0.14 -0.44 -0.11 -0.30 -0.41

Profile rs

Clinician 0.94 GN 0.84

Lay 0.92 0.95 VN 0.46 -0.09

NPD MA 0.81 0.87 0.82 AE 0.77 0.99 -0.20

GN MA 0.83 0.88 0.85 0.97 SA 0.82 0.43 0.79 0.30 VN MA 0.06 0.10 -0.05 0.39 0.22 NN 0.31 -0.25 0.97 -0.33 0.64 Narcissism and Narcissistic Personality Disorder 67

Note. Academic Profile = NPD profile as rated by academics (Lynam & Widiger, 2001); Clinician Profile = NPD profile as rated by clinicians (Samuel & Widiger, 2004); Lay Person = Narcissistic profile as rated by lay persons (Miller et al., 2018); NPD MA = Meta-analytically derived Narcissistic Personality Disorder profile (Samuel & Widiger, 2008); GN MA = Grandiose Narcissism meta-analytically derived profile (O'Boyle et al., 2015); VN MA = Vulnerable Narcissism meta-analytically derived profile (Campbell & Miller, 2013); Nar = Narcissism; GN = Grandiose Narcissism; VN = Vulnerable Narcissism; AE = Agentic Extraversion; SA = Self-centered Antagonism; NN = Narcissistic Neuroticism. * indicates narcissism factors measured by Crowe and colleagues (2019).

Table 2

Factor Score Correlations with Narcissism Scales NAR GN VN AE SA NN FFNI Total 0.94 0.84a 0.73b 0.80a 0.78a 0.57b Antagonism 0.88 0.78a 0.70b 0.65a 0.92c 0.45b Extraversion 0.76 0.82a 0.34b 0.89a 0.35b 0.31b Neuroticism 0.04 -0.27a 0.58b -0.18a -0.06c 0.77b FFNI Grandiose 0.9 0.93a 0.47b 0.88a 0.74c 0.27b FFNI Vulnerable 0.4 0.07a 0.84b 0.08a 0.36c 0.88b GNS Total 0.89 0.91a 0.50b 0.89a 0.64c 0.35b HSNS 0.55 0.26a 0.85b 0.22a 0.58c 0.80b NARQ 0.93 0.87a 0.65b 0.82a 0.78a 0.47b Admiration 0.83 0.92a 0.33b 0.94a 0.49c 0.22b Rivalry 0.71 0.52a 0.78b 0.40a 0.82c 0.58b NGS 0.82 0.93a 0.30b 0.91a 0.58c 0.13b NPI Total 0.87 0.95a 0.38b 0.97a 0.53c 0.26b G/E 0.78 0.79a 0.44b 0.79a 0.52c 0.34b L/A 0.73 0.86a 0.21b 0.90a 0.38c 0.12b E/E 0.83 0.79a 0.56b 0.76a 0.64c 0.43b PDQ-4+ NPD 0.87 0.75 0.74 0.68a 0.80c 0.56b PES 0.82 0.80a 0.53b 0.75a 0.67c 0.36b PID-5 NPD 0.92 0.89a 0.60b 0.85a 0.72c 0.44b Attention-seeking 0.76 0.70a 0.56b 0.72a 0.51b 0.48b Grandiosity 0.85 0.86a 0.49b 0.77a 0.77a 0.27b PNI Total 0.76 0.50a 0.92b 0.53a 0.55a 0.92b PNI Grandiose 0.75 0.67 0.59 0.74a 0.38c 0.60b PNI Vulnerable 0.64 0.33a 0.95b 0.33a 0.55c 0.94b SCID-II NPD 0.92 0.81 0.76 0.73a 0.86c 0.56b SD3 Narcissism 0.79 0.88a 0.30b 0.90a 0.47c 0.19b Narcissism and Narcissistic Personality Disorder 68

Note. All correlations greater than or equal to | r | = .11 are significant at p <.01. At each factor level (i.e., F3.1, F3.2, F3.3), correlations in the same row with different superscripts are significantly different from one another at p <.01. NAR = Narcissism; GN = Grandiose Narcissism; VN = Vulnerable Narcissism; AE = Agentic Extraversion; SA = Self-centered Antagonism; NN = Narcissistic Neuroticism; FFNI = Five Factor Narcissism Inventory – Short Form; GNS = Grandiose Narcissism Scale; HSNS = Hypersensitive Narcissism Scale; NARQ = Narcissistic Admiration and Rivalry Questionnaire; NGS = Narcissistic Grandiosity Scale; NPI = Narcissistic Personality Inventory; G/E = Grandiose Exhibitionism; L/A = Leadership/Authority; E/E = Entitlement/ Exploitativeness; PDQ-4+ = Personality Diagnostic Questionnaire-4; PES = Psychological Entitlement Scale; PID-5 = Personality Inventory for the DSM-5; PNI = Pathological Narcissism Inventory; SCID-II = Structured Clinical Interview for DSM-IV Personality Disorders Personality Questionnaire; SD3 = Short Dark Triad

Narcissism and Narcissistic Personality Disorder 69

Narcissism and Narcissistic Personality Disorder 70

Agentic Self-centered Narcissistic Extraversion Antagonism Neuroticism

FFNI FFNI-A FFNI-AE FFNI-N FFNI-G FFNI-V GNS HSNS NARQ NARQ-A NARQ-R NGS NPI NPI-G/E NPI-L/A NPI-E/E PDQ PES PID-NPD PID-AS PID-G PNI PNI-G PNI-V SCID SD3 0 0.2 0.4 0.6 0.8 1 0 0.2 0.4 0.6 0.8 1 0 0.2 0.4 0.6 0.8 1 Figure 2. Coverage of the trifurcated model of Narcissism by measure. Note. Coverage was calculated using data described by Crowe and colleagues (2019). Factor scores for each of the three factors were correlated with each scale score (see Table 2). Plots depict Pearson r2 values. FFNI = Five Factor Narcissism Inventory – Short Form; G = Grandiosity; V = Vulnerability; GNS = Grandiose Narcissism Scale; HSNS = Hypersensitive Narcissism Scale; NARQ = Narcissistic Admiration and Rivalry Questionnaire; NGS = Narcissistic Grandiosity Scale; NPI = Narcissistic Personality Inventory; G/E = Grandiose Exhibitionism; L/A = Leadership/Authority; E/E = Entitlement/Exploitativeness; PDQ-4+ = Personality Diagnostic Questionnaire-4 Narcissistic Personality Disorder Scale; PES = Psychological Entitlement Scale; PID-5 = Personality Inventory for the DSM-5; AS = Attention Seeking; PNI = Pathological Narcissism Inventory; SCID = Structured Clinical Interview for DSM-IV Personality Disorders Personality Questionnaire – NPD Scale; SD3 = Short Dark Triad