Narcissism particularly relates to a tendency to behave in a predominantly self-centred fashion, far more concerned about self than the interests and needs of other people. But it is far more than mere arrogance. Narcissism (previously referred to as megalo-mania) involves intense feelings of grandiosity or a mania for great or grandiose performance.
Narcissism as sometimes referred to as egoism and previously as megalomania, or “an unnaturally strong wish for power and control, or the belief that you are very much more important and powerful than you really are” (Cambridge)1
“Narcissism is a well-studied concept in clinical, forensic, and personality literature. Individuals high in narcissism are vain and grandiose. They have a heightened sense of entitlement, thinking that they deserve more than others because they are better than anybody else.” (Lyons, 2019)2
“Narcissism is characterised by traits such as dominance, self-confidence, a sense of entitlement, grandiosity and low empathy. There is growing evidence that individuals with these characteristics often emerge as leaders, and that narcissistic CEOs may make more impulsive and risky decisions.”(O’Reilly et al, 2013) 3
“Narcissism is more likely to relate to reactive aggression in circumstances where the narcissistic egos or goals are under threat.”(Lyons, 2019) 4
In addition to the separately identifiable “Grandiose-Manipulative” (GM) and “Daring-Impulsive” (DI) traits apparent in narcissistic (and psychopathic) individuals, the cold hearted and ruth-less (sympathy-free) or “Callous-Unemotional” (CU) trait refers to an absence of any genuine concern for the feelings and needs of others, viewed as little more than objects for manipulation.
“There has been a growing interest in how narcissistic leaders affect the organisations that they lead (as observed by O’Reilly et al, 2013 7 e.g., Maccoby, 2007; Padilla, Hogan, & Kaiser, 2007; Rosenthal & Pittinsky, 2006). 8 9 10
Research has suggested that narcissistic leaders—typically characterised by dominance, self-confidence, a sense of entitlement, grandiosity and low empathy—can both positively and negatively influence organisations.
On the positive side, narcissists are more likely to be seen as inspirational, succeed in situations that call for change, and be a force for creativity (Deluga, 1997; Gupta & Spangler, 2012; Maccoby, 2007). 11 12 13
On the negative side, narcissistic leaders have been shown to be more likely to violate integrity standards (e.g., Blickle, Schlegel, Fassbender, & Klein, 2006; O’Connor, Mumford, Clifton, Gessner, & Connelly, 1995). 14 15
Narcissistic leaders have unhappy employees and create destructive workplaces (Blair, Hoffman, & Helland, 2008), and inhibit the exchange of information within organisations (Nevicka, De Hoogh, Van Vianen, Beersma, & McIlwain, 2011). 16 17
While provocative, most of the empirical research on narcissism has been conducted using student samples. There is, however, some interesting theorising about how narcissism among senior managers might affect organisations (e.g., Campbell, Hoffman, Campbell, & Marchisio, 2011; Padilla et al., 2007).18
Campbell and his co-authors in researching Narcissism in organisational contexts suggested that narcissistic leaders may succeed in the short term, but over time, they “destroy the systems that they and others depend on to survive and thrive” (Campbell et al., 2011). 19
Rosenthal and Pittinsky for example, note that “narcissists have the charisma and vision that are vital to effective leadership,” but that these leaders are also prone to bullying subordinates, violating ethical standards and making risky decisions. 20
Despite the negativity they engender and negative outcomes their leadership can lead to, there is considerable evidence that people who are more narcissistic are more likely to emerge as leaders precisely because of their dominance and grandiosity” and it is not just researchers but those who have little option but to work with and for them who can testify to that (Brunell et al., 2008). 21
The DSM-5 was published in 2013 by the American Psychological Association after more than a decade of work by the APA’s Personality and Personality Disorder Work Group. Initially they actually recommended the removal of NPD diagnosis from the diagnostic manual, together with several other Personality Disorder, predominantly to reduce the number of diagnoses and to decrease the comorbidity or overlap between the diagnoses.
Several prominent personality disorder researchers argued against this (e.g., Miller et al., 2010), which led the working group to decide to retain the NPD diagnosis in DSM-5 without any changes from the prior manual.22
Hence the DSM-4 and DSM-5 Section II states that diagnosis of Narcissistic Personality Disorder requires a presence of
a pervasive pattern of grandiosity,
a need for admiration and
a lack of empathy,
together with five or more of the following:
grandiose sense of self-importance;
preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love;
beliefs of being special and unique;
requirements of excessive admiration;
a sense of entitlement;
envy of others;
arrogant and haughty behaviours or attitudes.
While the DSM is very much the diagnostic tool for mental health professionals in the USA, and of course beneficial for international clinicians and researchers, the global reference tool of all illnesses, including mental, is the ICD-11 from the World Health Organisation.
The “International Classification of Diseases 11th Revision” describes itself as “the global standard for diagnostic health information”, officially active from 1st January 2022.23
The DSM and ICD aim to become closer over time and this convergence ambition is reflected in “both the Alternative DSM-5 Model for Personality Disorders (AMPD) and the chapter on Personality Disorders (PD) in the recent version of ICD-11 embody(ing) a shift from a categorical to a dimensional paradigm for the classification of Personality Disorders.”24
“The “Alternative Model”, which was the product of the DSM-5 Personality and Personality Disorder Work Group, was approved by the DSM-5 Task Force and was intended for inclusion in Section II of DSM-5, “Diagnostic Criteria and Codes.”
However, the APA Board of Trustees voted to put the new model in Section III and to continue with the categories and criteria from DSM-IV for the Personality Disorders in DSM-5 Section II.”25
Indeed Section III of DSM-5 is no longer an “appendix” but includes tools to enhance diagnosis, as well as models for an evolving DSM of the future.
DSM-5 Task Force Chair David Kupfer, MD, emphasised that Section III “is not a dumping ground for material that doesn’t belong in Section II. What we are trying to do here is provide tools and techniques that can enhance the clinical decision-making process” by psychiatrists and other mental health professionals.26
Section III of DSM-5 contains “some diagnostic categories that require further research and/or more time for clinicians to become acquainted with before being included in Section II, as well as usable tools that should enhance diagnosis of the conditions listed in Section II.”
Skodol et al (2015) describe the related four step AMPD assessment process as beginning “with an evaluation of impairments in four elements of personality functioning—identity, self-direction, empathy, and intimacy—that were identified in the existing clinical literature as core aspects of Personality Disorder that can be reliably assessed… measured in combination on a single 5-point scale of severity”, essentially from non-existent or mild to severe. 27
“The second step in the assessment of a Personality Disorder is an evaluation of pathological personality traits.
The Alternative Model describes pathological personality according to five personality trait domains—negative affectivity, detachment, antagonism, disinhibition, and psychoticism—which correspond to the pathological “poles” of the well-known and widely validated five-factor model of personality.
Each trait domain consists of three to six more specific personality trait “facets” (e.g., emotional lability in the negative affectivity domain; impulsivity in the disinhibition domain).”28
The DSM-5 (APA, 2013) Section III Alternative Model states that the “essential features of a Personality Disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits” and for ALL Personality Disorders the impairments in personality functioning and the individual’s personality trait expression are:
relatively inflexible and pervasive or consistent across a broad range of personal and social situations;
relatively stable across time (with onsets that can be traced back to at least adolescence or early adulthood);
not better explained by another mental disorder;
not solely attributable to the physiological effects of a substance or another medical condition (e.g., a drug of abuse, medication); and are
not better understood as normal for an individual’s developmental stage or sociocultural environment.
To diagnose Narcissistic Personality Disorder, the DSM-V Alternative Model requires the following criteria to be met:
A. Significant impairments in personality functioning manifest by:
1. Impairments in self functioning (a or b):
a. Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem.
b. Self-direction: Goal-setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.
2. Impairments in interpersonal functioning (a or b):
a. Empathy: Impaired ability to recognise or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.
b. Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others‟ experiences and predominance of a need for personal gain
B. Pathological personality traits in the Antagonism domain, characterised by:
a. Grandiosity: Feelings of entitlement, either overt or covert; self-centredness; firmly holding to the belief that one is better than others; condescending toward others.
b. Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.
The grandiose narcissistic individual is more likely to regulate self-esteem through overt self-enhancement, denial of weaknesses, intimidating demands of entitlement, consistent anger in unmet expectation and devaluation of people that threaten self-esteem.
They have diminished awareness of the dissonance between their expectations and reality, along with the impact this has on relationships. Grandiose fantasies are an aspect of the individual’s overt presentation. Any conflict within the environment is generally experienced as external to these individuals and not a measure of their own unrealistic expectations.
The findings of Dickinson and Pincus (2003)31 concerning the overt social presentation of the grandiose narcissistic subtype were consistent with both theory (Kernberg, 1975; Kohut, 1971, 1977) and research (Hibbard & Bunce, 1995; Pincus & Wiggins, 1990; Wink, 1991) on this character style. 32 .33 34 35 36 37
Grandiose participants were rated as higher in Personality Disorder criteria for NPD, Antisocial Personality Disorder and Histrionic Personality Disorder. With regard to the NPD criteria, this finding accordant with the background of the development of the DSM category.
The higher ratings on the criteria for Antisocial Personality Disorder and Histrionic Personality Disorder were also in line with past research that indicated considerable comorbidity of these Cluster B Personality Disorders with NPD (such as Morey, 1988).38
“Comorbidity” is the simultaneous presence in an individual of more than one illness, disease or disorder.
The antisocial, narcissistic and histrionic personality disorders have criteria that belie a dramatic interpersonal presentation, with a tendency toward exhibitionism, attention-seeking and difficulties empathising with others. They are “overtly perceived as grandiose, arrogant and exhibitionistic.”
The grandiose narcissists reported interpersonal difficulties of a domineering and/or vindictive nature, low interpersonal distress and the majority selected attachment styles associated with positive self-representation (Secure, Dismissive).
Grandiose narcissistic individuals expect another’s immediate and undivided attention, and are oblivious to the effect their direct demands of entitlement have on others.
By virtue of their ability to maintain the grandiose self through self-enhancement, grandiose narcissistic individuals are less susceptible than their vulnerable peers to the chronic emotional consequences of threats to their entitled expectations (distress, lowered self-esteem, interpersonal fearfulness).
When provided with the opportunity, these individuals will say positive things about themselves and dismiss any potential weaknesses.
Research (Hibbard & Bunce, 1995; Pincus & Wiggins, 1990; Wink, 1991; Dickinson and Pincus (2003) that suggests that these individuals are actively self-enhancing, vindictive, aggressive, exhibitionistic and exploitative, while denying significant emotional or interpersonal stress.” 39 40 41 42
While they perceive themselves positively with regard to their experience in relationships and are likely to be dominant and assertive, others would likely describe their impact upon others more negatively than they themselves would perceive.
This overall finding confirms past theory and research that suggests that these individuals lack knowledge of the impact they have upon others, and thus, have an unrealistic view of themselves in relation to others (Gabbard, 1989, 1998; Kernberg, 1975; Kohut, 1971, 1977). 43 44 45 46 47
Indeed, this very lack of insight into their impact upon others is what incited Gabbard (1989) to enlist the label “oblivious narcissists” to describe their social presentation and distinguish them from their vulnerable associates. 48
The vulnerable subtype has been garnished with a variety of labels including closet narcissist (Masterson, 1993), hypervigilant narcissist (Gabbard, 1989), hypersensitive narcissist (Hendin & Cheek, 1997), vulnerable narcissist (Gersten, 1991; Hibbard & Bunce, 1995; Wink, 1991), and covert narcissist (Akhtar & Thomson, 1982; Cooper, 1998; Wink & Donahue, 1997). 49 50 51.52 53 54 55 56 57
Vulnerable narcissistic personality is observed as overtly presenting with shyness, constraint and even the appearance of empathy. Underlying this presentation, however, lies a covert core organised around grandiose expectations and entitlement.
Vulnerable narcissists are less equipped to use self-enhancement strategies (including self-praise) to modulate self-esteem, often needing external feedback from others to manage their self-esteem.
They are more likely to experience conflict around their entitled expectations, attempting to disavow or deny the underlying entitlement and continual disappointments.
Denial is a defence mechanism in which unpleasant thoughts, feelings, wishes or events are ignored or excluded from conscious awareness, an unconscious process that functions to resolve emotional conflict or reduce anxiety.
However, the disavowal of their own entitled expectations leads to brewing anger and hostile outbursts, followed by the experience of shame and depression. The fluctuation between shame/depression and overt anger influences the impression of rather labile (or moody) emotions.
Vulnerable narcissistic individuals experience much greater anxiety in developing relationships with others because of the tenuous nature of their self-esteem.
Chronic hypersensitivity and disappointment stemming from unmet entitled expectations is intolerable enough to promote social withdrawal and avoidance in an attempt to manage self-esteem (Cooper, 1998; Gabbard, 1989, 1998; Gersten, 1991; Kraus & Reynolds, 2001; Wink, 1991).58 59 60 61 62 63
However there appears to be considerable confusion in the diagnosis of NPD among clinicians (Gunderson, Ronningstam, & Smith, 1991), which may be due in part to differing theories of narcissism that guide the assessment of psychopathology (Cooper, 1998). 64 65
If the recognition of two types of narcissistic disorders is valid, overlooking the vulnerable type could contribute to false negative problems (narcissism not identified) and false positive problems (narcissism misidentified as another pathology).
Vulnerable narcissism could be misdiagnosed with at least two other distinct DSM Personality Disorders: Avoidant Personality Disorder (AVPD) and Borderline Personality Disorder (BPD) (Masterson, 2018).66
In the diagnosis of Avoidant PD, there are several criteria that may overlap with vulnerable narcissism:
Avoidant individuals are observed as appearing shy and being fearful of developing close relationships with others.
Individuals with AVPD may meet criteria for experiencing fears of feeling humiliated, rejected or embarrassed within individual relationships.
Finally, Millon (1996) proposes that the use of fantasy in individuals with AVPD is a major element in the presentation and perpetuation of this disorder. The use of fantasy has also long been denoted as primary to the realm of narcissism.67
The vulnerable narcissist is likely to exhibit significant interpersonal anxiety, avoidance of relationships and use of fantasy, but this is guided by a core of entitled expectations.
Vulnerable narcissists may avoid relationships in order to protect themselves from the disappointment and shame over unmet expectations of others, in contrast to fears of social rejection or making a negative social impact typical of Avoidant PD.
Another false positive diagnosis that may occur as a result of misinterpreting vulnerable narcissism is in the diagnosis of Borderline Personality Disorder (BPD).
As with social avoidance, the emotional lability of the vulnerable narcissist is influenced by their covert entitlement and difficulties managing disappointment and self-esteem threat.
In contrast, the emotionally lability of the individual with BPD is a byproduct of unrealistic anaclitic (powerlessness and fear of abandonment) needs (such as the need for a strong caretaker to manage his or her fears of being independent).’
Dickinson and Pincus’ found less statistical convergence of their vulnerable research candidates with borderline personality disorder which they believed confirmed their assertion that significant differences exist between the two distinct personality styles. 70
Despite the overt emotional lability of both borderline and vulnerably narcissistic individuals, there are meaningful differences in the types of problems these individuals would be expected to experience Kernberg, 1975; Masterson, 1993).71 72
Developmental Splitting between Grandiose & Vulnerable and Constructive & Destructive
“Though both constructs share the central concept of self-centredness, they manifest in very different personality types, which Wink (1991) originally referred to as the “two faces” (p. 590) of narcissism: subclinical Grandiose narcissists are extraverted, socially bold and even charming, Vulnerable narcissists, on the contrary, are introverted, defensive and avoidant. 73
While narcissistic grandiosity is characterised by overt expressions of feelings of superiority and entitlement, narcissistic vulnerability reflects hypersensitivity and introversive self-absorbedness.
Grandiose narcissism displays substantial correlation with extraversion, while vulnerable narcissism correlates highly with introversion…
Clinical observations show that patients diagnosed with narcissistic personality disorder (NPD), a pathological form of narcissism, display co-occurring or oscillating states of grandiosity and vulnerability”.74
“A recent systematic investigation found that individuals identified as grandiose narcissists are likely to display episodes of vulnerable narcissism as well” (Gore and Widiger, 2016).75
“In reality, the individual feels quite inferior about himself, using the defence mechanism of splitting to remain unaware of the conflict between his expression of grandiosity and his feelings of inferiority” (Kernberg, 1975) (Carr, 2008).76 77
Splitting is “a primitive defence mechanism used to protect oneself from conflict, in which objects provoking anxiety and ambivalence are dichotomised into extreme representations (part-objects) with either positive or negative qualities, resulting in polarised viewpoints that fluctuate in extremes of seeing the self or others as either all good or all bad.
This mechanism is used not only by infants and young children, who are not yet capable of integrating these polarised viewpoints, but also by adults with dysfunctional patterns of dealing with ambivalence; it is often associated with borderline personality disorder.” 78
People with emotional Personality Disorders often experience overwhelming emotions and struggle to integrate the concept that good and bad can co-exist in another person… For people with a Cluster B disorder including borderline, “splitting” is a commonly used defence mechanism that is done subconsciously in an attempt to protect against intense negative feelings such as loneliness, abandonment and isolation.
Splitting causes a person to view everything and everyone in black and white, ‘absolute’ terms. It stops them from being able to recognise or accept paradoxical qualities in someone or something and doesn’t allow for any “grey areas” in their thinking.
Seeing and responding to the world in these extremes, through either a filter of positivity or negativity, can leave the disordered person exhausted and emotionally drained. It can also lead to strains or fractures in their relationships as those close to the person become more and more affected by their behaviour.
A common symptom is emotional dysregulation – this is where a person is less able to manage their emotional responses than individuals who don’t struggle with a Personality Disorder.
Therefore, when a person with the disorder splits and perceives something or someone to be entirely good or bad, they are likely to respond in a way that falls outside what would be expected.
These extreme emotions can be exhausting, both to the person with the disorder and those who are closest to them, who could be friends, family or coworkers.
When a real or perceived slight is then experienced by the disordered person, this can cause them to feel disappointed, betrayed, unloved or abandoned, and view the other party as entirely bad. The individual may then become angry, or withdraw entirely. 79
Splitting can also be used by psychopaths to create a narrative whereby they are the victim.
“Within the area of psychoanalysis, splitting refers to a coping mechanism whereby an individual, unable to integrate certain particularly difficult feelings or experiences into the overall ego structure, compartmentalises his or her reaction to those feelings or experiences. This is also often referred to as ego disintegration or, in extreme cases, dissociation.
Splitting was first described by Sigmund Freud, and was later more clearly defined by his daughter Anna Freud. Splitting can be explained as thinking purely in extremes, such as good versus bad, powerful versus defenceless and so on.
A two-year-old child cannot see a person who does something unpleasant to the child (e.g. not feeding him when he is hungry), as possessing just one or a few bad characteristic(s). This is too complicated for the not yet fully developed brain. The other can only been seen as all bad at that moment in time. However, when this person gratifies the child, he will be perceived as all good again. Splitting can be seen as a developmental stage and as a defence mechanism.”80
In the object relations theory of Melanie Klein, she states that children are born with two primary drives: a caring, loving one and a destructive, hateful one. All humans struggle throughout their entire lives to integrate these two drives into constructive relations.
An important step in the development of children is to overcome the splitting of these two drives, which is the central theme of the paranoid-schizoid position, conceived of by Melanie Klein as the state of mind existing in babies of three or four to six months of age, but one that is constantly returned to throughout life to greater or lesser degrees.
Klein emphasises that the good and bad parts of the self are projected onto or into the object, such as the mother. This represents the operation of the life and death instincts, of love and hate. As the child matures and as a result of predominantly good experiences being taken in, the baby gradually begins to be able to bring together the good and bad objects into a single object. 81
As an Object Relations Theorist, Klein sees emotions as always existing in relation to other people or “objects” of emotions or feelings. In the paranoid schizoid position, relations are also characterised by being all “good” or all “bad”. People in the child’s world are thus split into two objects, hence the “schizoid” in paranoid schizoid.
According to Klein, splitting refers to the separation of the things the child loves (good, gratifying objects) and the things the child hates (bad, frustrating objects)… The child has to learn that others and objects can be good and bad.82
In the developmental model of Otto Kernberg, the overcoming of splitting is also an important developmental task. The child has to learn to integrate feelings of love and hate.
If a person fails to accomplish this developmental task, borderline pathology can develop. The borderline personality is not able to integrate the good and bad images of both self and others. Kernberg also states that people who suffer from borderline personality disorder have a ‘bad representation’ which dominates the ‘good representation’.
Splitting creates instability in relationships, because one person can be viewed as either all good or all bad at different times, depending on whether he or she gratifies needs or frustrates them. This, and similar oscillations in the experience of the self, lead to chaotic and unstable relationship patterns, identity diffusion and mood swings.
People who are diagnosed with a narcissistic personality disorder also use splitting as a central defence mechanism. They do this to preserve their self-esteem, their overall evaluation or appraisal of their own worth.. They do this by seeing the self as purely good and the others as purely bad. The use of splitting also implies the use of other defence mechanisms, namely devaluation, idealisation and denial.83 84
Denial is a defence mechanism postulated by Sigmund Freud, in which a person is faced with a fact that is too uncomfortable to accept and rejects it instead, insisting that it is not true despite what may be overwhelming evidence.85
When viewing people as all good, the individual is said to be using idealisation: a mental mechanism in which the person attributes exaggeratedly positive qualities to the self or others.
When viewing people as all bad, the individual employs devaluation: attributing exaggeratedly negative qualities to the self or others.86
Heinz Kohut’s “self-object transferences” involved idealisation and mirroring, or copying what someone else is doing while communicating with them. Kohut stated that, with narcissistic patients, idealisation of the self and the therapist should be allowed during therapy and then very gradually will diminish.
To Kohut, idealisation in childhood is a healthy mechanism. If the parents fail to provide appropriate opportunities for idealisation (healthy narcissism) and mirroring (how to cope with reality), the child does not develop beyond a developmental stage in which he sees himself as grandiose but in which he also remains dependent on others to provide his self-esteem.
Indeed before Narcissistic Personality Disorder (NPD) took its present name, it was commonly referred to as Megalomania, a term first used by Heinz Kohut in 1971.
Narcissistic personality disorder is thus a psychological disorder resulting from a person’s belief that he or she is flawed in a way that makes the person fundamentally unacceptable to others. This belief is held below the person’s conscious awareness. Indeed such a person would typically deny thinking such a thing if questioned.
In order to protect themselves against the intolerably painful rejection and isolation they imagine would follow if others recognised their supposedly defective nature, such people make strong attempts to control others’ view of them and behaviour towards them.
The common use of the term “narcissism” refers to some of the ways people defend themselves against this narcissistic dynamic: a concern with one’s own physical and social image, a preoccupation with one’s own thoughts and feelings and a sense of grandiosity.
There are, however, many other behaviours that can stem from narcissistic concerns, such as immersion in one’s own affairs to the exclusion of others, an inability to empathise with others’ experience, interpersonal rigidity, an insistence that one’s opinions and values are “right” and a tendency to be easily offended and take things personally.
To the extent that people are narcissistic, they can be controlling, blaming, self-absorbed, intolerant of others’ views, unaware of other’s needs and of the effects of their behaviour on others, and require that others see them as they wish to be seen.
People who are narcissistic commonly feel rejected, humiliated and threatened when criticised. To protect themselves from these dangers, they often react with disdain, rage, and/or defiance to any slight, real or imagined, 87 all of which are traits this research associates with “Destructive Leadership” as (mal) practiced by “Disordered Leaders”.
(C) Julian M Clarke (2022)
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