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The Science of Narcissism Beyond Psychopathology
Clinical and Sociological Perspectives
What is the science of narcissism? Is it a clinical discipline? Is it the study of behavior or just personality? What are the sociological factors that influence how we perceive ourselves? How do collectivistic cultures perceive and treat others compared to individualistic cultures?
A diverse group of practitioners and scientists, including psychiatrists, clinical psychologists, criminologists, anthropologists, personality and social psychologists, sociologists, organizational behavior management specialists, and others have long attempted to understand narcissism from various perspectives. In recent years, more collaboration among mental and behavioral health professionals has helped cultivate an integrated approach to studying the science of narcissism.
Unfortunately, as with ADHD and OCD, the term narcissism has become so popularized that we’ve distorted perceptions surrounding the severity of the psychopathology and have diminished regard for the intended use of the diagnosis. Instead, we have stigmatized the serious mental illness of NPD and weaponized a clinical lexicon around personality pathology that is still evolving.
As an open concept, narcissism is an ambiguous and imprecise term. It may refer to pathology or normative behavior that occurs along a spectrum. Communicating psychological jargon with imprecision and lack of clarity leads to thinking about psychological terms with a disregard for accuracy (Lilienfeld et al., 2015). Because narcissism is both a clinical presentation and cultural characterization, the application of the diagnostic label to a whole society is problematic and further obscures the definition of the term as it applies clinically, subclinically, and culturally (Grubner, 2017).
Narcissism is both complex and controversial. Clinical narcissism or narcissistic personality disorder (NPD) is one of the least scientifically studied personality disorders, but one the most familiar to the general public. In recent years, we have heard a lot about NPD in media outlets but very little about the nine other personality disorders recognized in Clusters A, B, and C in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-V).
In 1980, when NPD was first included in the DSM, what was known about personality disorders was based largely on clinical case studies. Only recently has systematic empirical research been cited in the diagnostic reference manual to support findings from clinical sources. Unfortunately, there is still a paucity of empirical data available on narcissistic personality disorder.
The DSM-V and the International Statistical Classification of Diseases and Related Health Problems, 10th Edition do not currently include subtypes or variants for diagnostic consideration but many variants of narcissism have been described in the scientific literature. Grandiose narcissism, which is characterized by extroversion, a sense of entitlement, and feelings of superiority, and vulnerable narcissism, which is characterized by introversion, neuroticism, and hypersensitivity represent the most commonly referenced subtypes in peer-reviewed journals. Grandiose (overt) narcissism is much easier to recognize than vulnerable (covert) narcissism.
While politicians, lawyers, and executives from entertainment and corporate America typically make lists of popular professions that draw narcissists, academia and the priesthood are also popular vocational venues for these individuals. Motivational speaking and reality television stars are also at the top of the list.
Diagnosing narcissistic personality disorder is challenging for clinicians because the psychopathology presents with considerable trait heterogeneity and a high prevalence of comorbidity with other mental illnesses (Caligor et al., 2015). Malignant narcissism, although not a diagnostic construct, refers to individuals who exhibit a combination of narcissistic personality disorder, antisocial personality disorder, and other dark triad personality traits (Paulhus and Williams, 2002).
Narcissistic Personality Disorder has been attributed to a genetic predisposition and developmental trauma. Some practitioners also propose that excessive adoration and praise of children may contribute to narcissism in adulthood.
While the label of narcissism has been popularized, overused, and misused, prevalence rates of only 0.5 to 5 percent of the US population have been reported in the community. In clinical settings, the rate may be much higher. Estimates suggest that 1 to 15 percent of patients present with narcissistic personality disorder (Mitra and Fluyau, 2021).
Considering the diagnostic confusion that presents for clinicians, it should be no surprise that narcissism continues to be misunderstood and misrepresented by laypersons. When most people think of narcissism they envision grandiose traits as described in the DSM and ICD. But the impairment associated with the internal struggle of the vulnerable narcissist may be integral to the dysfunction. In fact, the co-occurrence of both grandiose and vulnerable traits in NPD explain the pathological personality of the clinical narcisissist (Brogaard, 2019).
Social and personality psychologists tend to examine grandiosity as it presents in agentic and communal narcissism. In agentic narcissism, self-promotion and admiration are hallmarks of grandiosity. In communal narcissism, grandiosity is veiled in service and saviorship (Nehrlich et al., 2019).
Sociologists study narcissism across generations and in the context of cultural theory. These social scientists endeavor to understand the normative traits associated with subclinical narcissism and how narcissistic behavior manifests as a cultural phenomenon in modern societies (Twenge, 2011). Studies of cultural narcissism have been criticized because they have examined grandiose narcissism to the exclusion of the vulnerable subtype (Vater et al., 2018).
Narcissism can also be quite adaptive and beneficial to our mental health. For example, narcissistic traits buffer us from stress and ultimately other mental illnesses impacted by stress (Lyons et al., 2019). We all fall somewhere on the spectrum and undoubtedly interact with people who exhibit subclinical narcissism or clinical narcissism. Like other spectra ‘disorders’, narcissism is a continuous distribution of symptoms.
There remains a fractured appreciation and misaligned understanding of narcissistic behavior compared to narcissistic personality that leads to misperceptions and challenges in how we relate with others. A gap exists between our understanding of narcissism as an inherent characteristic of our species and our understanding of severe pathology. A future direction in the study of narcissism may be to explore specific psychopathologies from an evolutionary framework (Del Giudice and Haltigan, 2021).
Related Resources on the Drop-in Social Audio App Clubhouse.com:
Scapegoat Strength https://www.clubhouse.com/scapegoatstrength
Rise Like a Phoenix https://www.clubhouse.com/club/rise-like-a-phoenix
Hacking Narcissism https://www.clubhouse.com/club/hacking-narcissism
Brogaard, B. (2019) Vulnerable Vs Grandiose Narcissism: Which Is More Harmful? Psychology Today https://www.psychologytoday.com/us/blog/the-mysteries-love/201906/vulnerable-vs-grandiose-narcissism-which-is-more-harmful
Del Giudice, M., Haltigan J. (2021) An integrative evolutionary framework for psychopathology. Dev Psychopathol. Aug 9:1-11. https://doi/10.1017/S0954579421000870
Grubner, B. (2017). Narcissism in cultural theory: Perspectives on Christopher Lasch, Richard Sennett, and Robert Pfaller. Frontiers of Narrative Studies, 3(1), 50-70. https://doi.org/10.1515/fns-2017-0004
Lilienfeld, S. O., Sauvigné, K. C., Lynn, S. J., Cautin, R. L., Latzman, R. D., & Waldman, I. D. (2015). Fifty psychological and psychiatric terms to avoid: a list of inaccurate, misleading, misused, ambiguous, and logically confused words and phrases. Frontiers in psychology, 6, 1100. https://doi.org/10.3389/fpsyg.2015.01100
Lyons, M., Evans, K., Helle, S. (2019) Do “Dark” Personality Features Buffer Against Adversity? The Associations Between Cumulative Life Stress, the Dark Triad, and Mental Distress Sage Open https://doi.org/10.1177/2158244018822383
Mitra, P., Fluyau, D. Narcissistic Personality Disorder. [Updated 2021 May 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing https://www.ncbi.nlm.nih.gov/books/NBK556001/
Nehrlich, A., Gebauer, J., Sedikides, C., Schoel, C. (2019) Agentic narcissism, communal narcissism, and prosociality. J Pers Soc Psychol. (1):142-165. https://doi/10.1037/pspp0000190.
Paulhus, D. and Williams, K. (2002) The dark triad of personality: Narcissism, machiavellianism, and psychopathy. Journal of Research in Personality 36 https://doi/ 10.1016/S0092-6566(02)00505-6
Twenge, J. M. (2011). Narcissism and culture. In W. K. Campbell & J. D. Miller (Eds.), The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings, and treatments (pp. 202–209). John Wiley & Sons, Inc.
Vater, A., Moritz, S., & Roepke, S. (2018). Does a narcissism epidemic exist in modern western societies? Comparing narcissism and self-esteem in East and West Germany. PloS one, 13(1) https://doi.org/10.1371/journal.pone.0188287
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