Milano-Bicocca University Department of Psychology Doctoral Dissertation in Social, Cognitive, and Clinical Psychology XXVI Cycle Uncovering Narcissism: Developing Reliable Rorschach Indicators and Understanding the Construct in Depth Through Multimethod Investigation from Childhood to Adulthood in Clinical and Experimental Settings Doctoral Candidate: Emanuela S. V. Gritti Coordinator: Prof. Marco Perugini Supervisor: Prof. Margherita Lang Milan, Italy, 2014 Abstract The construct of narcissism is at the same time surrounded by wide interest in clinical and research settings and important controversies about its conceptual definition and phenomenological description. Theoretical issues involve diverging ideas about the essence of narcissism itself, arising from different branches of psychology and psychiatry and lacking a unanimously accepted definition. Whereas the most accepted diagnostic manuals emphasize a high self-esteem dimension in their description of narcissism, influential clinical theories and studies from personality psychology depict individuals with a narcissistic functioning as characterized not only by a grandiose sense of self but rather by a continuous and painful oscillation between high and low self-esteem states. In this view, grandiose behaviors could be interpreted as a defensive reaction towards inadequacy feelings. The scenario is complicated even further by the fact that empirical research on narcissism is characterized by specific methodological and assessment issues. Narcissism is in fact particularly sensitive to the diagnostic method used, with evident limitations connected to an assessment relying on self-report measures only. Therefore, there is a need for an implicit measure of narcissism that can complement the results of other methods. The present investigation represents the development of a set of 11 potential Rorschach variables for assessing narcissistic functioning and grandiosity along with related psychological constructs. Rorschach protocols from Italian and American clinical and nonclinical groups of different ages were scored for variables connected to narcissistic functioning, some of which we modified from previous literature: Omnipotence and Idealization; Reflection, Personal Knowledge Justification, Exhibitionism, Magic, and Elevated Mood States; and some of which we developed: Expanded Personal Reference, i Narcissistic Devaluation, Narcissistic Deflation, Narcissistic Denial. The presence of a grandiosity factor was then evaluated by principal components analysis and its validity tested by computing correlations with external criteria. Also in an attempt to throw light on the status of narcissism in developmental age, clinical preadolescent and adolescent groups were involved as well, with the possibility to identify any peculiarities that may be connected to the assessment of these variables at specific ages. Along with clinical studies, in the present investigation an experimental paradigm was used in order to systematically study the relationships between the narcissistic variables and nonclinical individuals’ reactions to manipulations of self-esteem. Overall, findings support the utility of a multimethod assessment for narcissism, focused not only on how individuals understand and describe themselves but also on how they perceive the world and interact with it. Results about narcissistic functioning in preadolescents and adolescents contribute to fill a gap in the field considering the general lack of consensus about the possibility to conceptualize narcissism in children as different from a normal feature of development. ii Table of contents Abstract ………..……………………………………………………………………….. i Table of Contents ……………………………………………………………………… iii Chapter I: Literature Review…………………………………………………………. 1 Chapter II: Assessing Narcissism Using Rorschach-Based Imagery and Behavior 41 Validated by Clinician-Reports: Studies with clinical and nonclinical adults……... Study 1: Normative adults………………………………………………………... 50 Sample ………………………………...................................................... 51 Materials ………………………………………………………………. 52 Statistical Procedure ……..……………………………………………. 53 Results 55 Study 2: Clinical Adults ………………………………………………………….. 57 Participants: Patients and Clinicians ………………………………... 58 Materials ……………………………………………………………… 60 Statistical Procedure ……..……………………………………………. 63 Results ..………………………………………………………………… 66 Discussions for Study 1 and Study 2……..………………………….... 72 Appendix………………………………………………………………... 76 Chapter III: Narcissistic Functioning in Children and Adolescents: Multi- 83 method clinical studies with the Rorschach Inkblot Method………………………. Outline of the Developmental Studies ……..………………………………... 89 Study 1: Clinical Preadolescents ..…………………………………………… 90 iii Participants …………………………………………………………….. 90 Materials ……………………………………………………………….. 90 Statistical Procedure …………………………………………………... 97 Expected Findings ……………………………………………………... 101 Results ………………………………………………………………….. 101 Study 2: Clinical Adolescents ………………………………........................... 106 Participants …………………………………………………………….. 106 Materials ……………………………………………………………….. 107 Statistical Procedure …………………………………………………... 108 Expected Findings ……………………………………………………... 110 Results ………………………………………………………………….. 111 Discussions for Study 1 and Study 2 ………………………………………… 116 Chapter IV: Narcissistic Self-Esteem, Anger and Defensive Patterns: An 123 experimental design with the Rorschach Inkblot Method …………………………. Outline …………………………………………………………………. 128 Participants and Recruitment Process ……………………………….. 128 Materials ……………………………………………………………….. 129 Procedure ………………………………………………………………. 133 Aims and Hypotheses ………………………………………………….. 138 Statistical Analyses: Main Steps ……………………………………… 139 Results Section I: Factor Extraction on the GNVs ………………….. 141 Results Section II: Narcissism in Relation to Self-Esteem 147 Manipulation …………………………………………………………... iv Discussions ……………………………………………………………... 156 Chapter V: Summary, General Discussions and Final Considerations …………... 163 Acknowledgments …………………………………………………………………….. 173 References ………………………..…………………………………………………… 175 v [“è inutile” soggiunse, “non abbiamo più la saggezza degli antichi, è finita l’epoca dei giganti!”. “Siamo nani,” ammise Guglielmo, “ma nani che stanno sulle spalle di quei giganti, e nella nostra pochezza riusciamo talora a vedere più lontano di loro sull’orizzonte.” Dialogo fra Abbone da Fossanova e Guglielmo da Baskerville] U. Eco, 1980 vi Chapter I Literature Review Defining, studying and unanimously describing the concept of narcissism might be one of the hardest but at the same time valuable ventures for contemporary research in psychology and psychiatry. Ironically enough, as foreseen by the myth of Narcissus, the concept of narcissism has captured vivid interest and has been “in the spotlight” of clinical literature and research for over a century, being one of the key (and controversial) concepts of psychoanalysis itself. However, as will be discussed further, the history of the construct dates back even before the advent of psychoanalytic ideas as we know them today, and has been everything but linear. Epistemological challenges and debates have in fact traditionally surrounded the construct of narcissism, which has been discussed in very heterogeneous scientific scenarios that go from psychodynamic approaches (e.g. Kernberg, 1978, 1984; Kohut, 1971, 1977; Ronningstam, 2009, 2011, 2012), to more recent social-psychological experimental studies (Rhodewalt & Morf, 1998; Morf & Rhodewalt, 2001), to trait models (Miller & Campbell, 2010; Miller et al., 2011; Samuel & Widiger, 2008) and to contemporary personality researchers and theorists (Baumeister, Bushman, & Campbell, 2000; Campbell, 1999; Dickinson & Pincus, 2003; Emmons, 1981, 1984, 1987, 1989; John & Robins, 1994; Raskin & Hall, 1979; Raskin & Novacek, 1989). In the multifaceted array of conceptualizations on narcissism, the term has been used with rather different meanings, at times conceived as a personality trait and in other contexts presented as a psychopathological personality configuration. Yet the construct has been employed by authors from outside psychology and psychiatry literature such as, just to cite a few, the sociologist Theodore Adorno (1968), the 1 cultural historian Christopher Lasch (1979) and the socio-economic journalist Tom Wolfe (1976). Contrarily to what could be expected considering such an influence over the lay public and modern society, together with the longstanding history in psychology that characterized narcissism through the years, the construct is not associated to a commensurate solid scientific status. In fact, narcissism has often been studied from a theoretical rather than empirical point of view, and its clinical counterpart, Narcissistic Personality Disorder (NPD) is one of the less empirically studied personality disorders (Paris, 2003; Stinson, Dawson, Goldstein et al., 2008; Miller & Campbell, 2010). In fact, except for more recent studies that focused on the impact of NPD traits on the quality of life and functional impairment in clinical and community samples (Cramer, Torgersen, & Kringlen, 2006; Miller, Campbell, & Pilkonis, 2007), systematic works have generally involved more observable and externalizing PDs such as Antisocial and Borderline. Along with a relative scarcity of systematic studies about NPD in comparison to other personality disorders, discordant prevalence rates have been reported, going from the more recent 6% obtained in the general population