Personality Disorders: Theory, Research, and Treatment 2014, Vol. 5, No. 4, 448 – 449
© 2014 American Psychological Association 1949-2715/14/$12.00 http://dx.doi.org/10.1037/per0000081
COMMENTARY
The Maturation of Narcissism: Commentary for the Special Series “Narcissistic Personality Disorder—New Perspectives on Diagnosis and Treatment” Christopher J. Hopwood This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Michigan State University
shown in their case examples, some narcissists do not display grandiosity in the obvious sorts of ways emphasized by Section II of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) and some existing measures; however, their fundamental problems still appear to involve fragility in the self-system that is associated with socially maladaptive compensatory behaviors. These patients are misclassified in a diagnostic approach that is superficially focused on external behavior, and misclassification can often result in treatment approaches that do not recognize or deal with the patient’s underlying fragility. Ronningstam (2014, pp. 434 – 438) accordingly emphasizes the importance of a careful assessment of patient dynamics. The same person can give a lecture in front of 10,000 people to rave reviews one day, and several days later may be too anxious and self-critical to speak in front of eight people. How can a single datum account for that? Both of the above articles suggest that narcissism is a construct that is too complicated for a single assessment or diagnostic interview. An exciting line of research focusing on the temporal aspects of narcissism via dynamic assessments seems poised to lead to clinically tractable methods that can account for narcissistic patterns (e.g., Roche, Pincus, Conroy, Hyde, & Ram, 2013). Diamond et al. (2014, pp. 428 – 433) show that when coupled with borderline personality, pathological narcissism is a recipe for regressive working models involving disorganization and internal incoherence that give way to conflicting attachment strategies often entailing the devaluation of others. In other words, pathological narcissism seems to add to the already severely dysregulated attachment system of patients with borderline personality a tendency toward dysregulated agency. This research is important in demonstrating the value of retaining narcissism as a construct, particularly given that it has recently been on the chopping block in the diagnostic manuals. However, as emphasized by Skodol, Bender, and Morey (2014, pp. 422– 427), the DSM-5 Section III model represents a significant improvement in clinical utility over the Section II model of DSM’s past by bringing the construct closer to its clinical roots. Criterion A features in particular add depth to the descriptive approach of Section II and restore historical connections to clinically useful conceptions of narcissism. Specifically, the emphasis on vacillations in self-esteem and the tendency, when threatened, to exhibit maladaptive agency appears to reflect some of the more vulnerable aspects of narcissism that have long been emphasized by clinical theorists. This series of articles raises an interesting meta-issue worthy of further consideration: How specific is vulnerability to narcissism?
Conceptualizations of narcissism in psychology and psychiatry vary widely; as a result, a range of assessment tools that differ substantially in their representation of narcissism are currently available. Many of these tools do not represent the description of narcissism within the clinical literature all that well (Cain, Pincus, & Ansell, 2008). Clinical theorists have tended toward a developmental perspective, in which narcissism is understood as a delay in the capacity for regulating strivings for power and mastery (e.g., Kohut, 1971). The concept is rich but simple: Children are born the helpless centers of their own universe. Growing up involves a series of confrontations with the fact that human beings, as individuals, are not so special. Successful adulthood typically entails developing the capacity to care for someone else at least as much as one’s self, with the goal of caring mostly about other people by the time of one’s death. Thus, although it is understandable and perhaps even adaptive to be narcissistic when young, it is increasingly less adaptive with age. In adults, narcissism essentially means falling behind. Given its developmental nature, most people who remember being a child have some insights into the phenomenology of narcissism. Like the child who dresses up as a superhero or movie star, there is a delicate veneer of maturity in the narcissist that covers a brittle self-esteem and vulnerability to ego threat. Threats are usually responded to with reactive, dysregulated agency (e.g., aggression, pomposity, entitlement, dominance). Children can often get away with this kind of behavior. Pathological narcissism occurs when an adult acts like a child who lashes out because his or her self-esteem has been threatened; unlike with children, this often comes with social costs. In part because of the failure to focus on developmental dynamics, many of the narcissism tools upon which existing theory and research have been based overemphasize behavioral displays of grandiosity and underemphasize the inner experience of vulnerability. The Pincus, Cain, and Wright (2014, pp. 439 – 443) article highlights the importance of recent course corrections in contemporary conceptions of narcissism toward a more clinically informed perspective. As
Correspondence concerning this article should be addressed to Christopher J. Hopwood, Psychology Department, Michigan State University, 316 Physics Room 107A, East Lansing, MI 48824. E-mail: hopwood2@ msu.edu 448
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
THE MATURATION OF NARCISSISM
Is this a “Criterion A” feature of most personality disorders, with variants (e.g., paranoid, histrionic, etc.) defined by how one reacts to an inner sense of fragility, vulnerability, or immaturity? Or should vulnerability be more meaningfully incorporated into the specific criteria for narcissistic personality disorder, which have tended to overemphasize grandiosity? These are important questions that can only be worked out meaningfully with further research. Doing so might not only clarify the nature of narcissism, but also lead to more effective models for understanding personality pathology in general. A possible silver lining around the turmoil of this construct’s adolescence is that as the psychometric acne clears and measurement becomes more closely linked to developmental theory and phenomenology, narcissism might eventually become more widely regarded as an empirically mature and clinically respected form of psychopathology.
References Cain, N. M., Pincus, A. L., & Ansell, E. B. (2008). Narcissism at the crossroads: Phenotypic description of pathological narcissism across clinical theory, social/personality psychology, and psychiatric diagnosis.
449
Clinical Psychology Review, 28, 638 – 656. doi:10.1016/j.cpr.2007.09.006 Diamond, D., Levy, K. N., Clarkin, J. F., Fischer-Kern, M., Cain, N. M., Doering, S., . . . Buchheim, A. (2014). Attachment and mentalization in female patients with comorbid narcissistic and borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 5, 428 – 433. doi:10.1037/per0000065 Kohut, H. (1971). The analysis of the self. New York, NY: International Universities Press. Pincus, A. L., Cain, N. M., & Wright, A. G. C. (2014). Narcissistic grandiosity and narcissistic vulnerability in psychotherapy. Personality Disorders: Theory, Research, and Treatment, 5, 439 – 443. doi:10.1037/ per0000031 Ronningstam, E. (2014). Beyond the diagnostic traits: A collaborative exploratory diagnostic process for dimensions and underpinnings of narcissistic personality disorder. Personality Disorders: Theory, Research, and Treatment, 5, 434 – 438. doi:10.1037/per0000034 Roche, M. J., Pincus, A. L., Conroy, D. E., Hyde, A. L., & Ram, N. (2013). Pathological narcissism and interpersonal behavior in daily life. Personality Disorders: Theory, Research, and Treatment, 4, 315–323. doi:10.1037/ a0030798 Skodol, A. E., Bender, D. S., & Morey, L. C. (2014). Narcissistic personality disorder in DSM-5. Personality Disorders: Theory, Research, and Treatment, 5, 422– 427. doi:10.1037/per0000023
© 2014 American Psychological Association 1949-2715/14/$12.00 http://dx.doi.org/10.1037/per0000081
COMMENTARY
The Maturation of Narcissism: Commentary for the Special Series “Narcissistic Personality Disorder—New Perspectives on Diagnosis and Treatment” Christopher J. Hopwood This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Michigan State University
shown in their case examples, some narcissists do not display grandiosity in the obvious sorts of ways emphasized by Section II of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) and some existing measures; however, their fundamental problems still appear to involve fragility in the self-system that is associated with socially maladaptive compensatory behaviors. These patients are misclassified in a diagnostic approach that is superficially focused on external behavior, and misclassification can often result in treatment approaches that do not recognize or deal with the patient’s underlying fragility. Ronningstam (2014, pp. 434 – 438) accordingly emphasizes the importance of a careful assessment of patient dynamics. The same person can give a lecture in front of 10,000 people to rave reviews one day, and several days later may be too anxious and self-critical to speak in front of eight people. How can a single datum account for that? Both of the above articles suggest that narcissism is a construct that is too complicated for a single assessment or diagnostic interview. An exciting line of research focusing on the temporal aspects of narcissism via dynamic assessments seems poised to lead to clinically tractable methods that can account for narcissistic patterns (e.g., Roche, Pincus, Conroy, Hyde, & Ram, 2013). Diamond et al. (2014, pp. 428 – 433) show that when coupled with borderline personality, pathological narcissism is a recipe for regressive working models involving disorganization and internal incoherence that give way to conflicting attachment strategies often entailing the devaluation of others. In other words, pathological narcissism seems to add to the already severely dysregulated attachment system of patients with borderline personality a tendency toward dysregulated agency. This research is important in demonstrating the value of retaining narcissism as a construct, particularly given that it has recently been on the chopping block in the diagnostic manuals. However, as emphasized by Skodol, Bender, and Morey (2014, pp. 422– 427), the DSM-5 Section III model represents a significant improvement in clinical utility over the Section II model of DSM’s past by bringing the construct closer to its clinical roots. Criterion A features in particular add depth to the descriptive approach of Section II and restore historical connections to clinically useful conceptions of narcissism. Specifically, the emphasis on vacillations in self-esteem and the tendency, when threatened, to exhibit maladaptive agency appears to reflect some of the more vulnerable aspects of narcissism that have long been emphasized by clinical theorists. This series of articles raises an interesting meta-issue worthy of further consideration: How specific is vulnerability to narcissism?
Conceptualizations of narcissism in psychology and psychiatry vary widely; as a result, a range of assessment tools that differ substantially in their representation of narcissism are currently available. Many of these tools do not represent the description of narcissism within the clinical literature all that well (Cain, Pincus, & Ansell, 2008). Clinical theorists have tended toward a developmental perspective, in which narcissism is understood as a delay in the capacity for regulating strivings for power and mastery (e.g., Kohut, 1971). The concept is rich but simple: Children are born the helpless centers of their own universe. Growing up involves a series of confrontations with the fact that human beings, as individuals, are not so special. Successful adulthood typically entails developing the capacity to care for someone else at least as much as one’s self, with the goal of caring mostly about other people by the time of one’s death. Thus, although it is understandable and perhaps even adaptive to be narcissistic when young, it is increasingly less adaptive with age. In adults, narcissism essentially means falling behind. Given its developmental nature, most people who remember being a child have some insights into the phenomenology of narcissism. Like the child who dresses up as a superhero or movie star, there is a delicate veneer of maturity in the narcissist that covers a brittle self-esteem and vulnerability to ego threat. Threats are usually responded to with reactive, dysregulated agency (e.g., aggression, pomposity, entitlement, dominance). Children can often get away with this kind of behavior. Pathological narcissism occurs when an adult acts like a child who lashes out because his or her self-esteem has been threatened; unlike with children, this often comes with social costs. In part because of the failure to focus on developmental dynamics, many of the narcissism tools upon which existing theory and research have been based overemphasize behavioral displays of grandiosity and underemphasize the inner experience of vulnerability. The Pincus, Cain, and Wright (2014, pp. 439 – 443) article highlights the importance of recent course corrections in contemporary conceptions of narcissism toward a more clinically informed perspective. As
Correspondence concerning this article should be addressed to Christopher J. Hopwood, Psychology Department, Michigan State University, 316 Physics Room 107A, East Lansing, MI 48824. E-mail: hopwood2@ msu.edu 448
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
THE MATURATION OF NARCISSISM
Is this a “Criterion A” feature of most personality disorders, with variants (e.g., paranoid, histrionic, etc.) defined by how one reacts to an inner sense of fragility, vulnerability, or immaturity? Or should vulnerability be more meaningfully incorporated into the specific criteria for narcissistic personality disorder, which have tended to overemphasize grandiosity? These are important questions that can only be worked out meaningfully with further research. Doing so might not only clarify the nature of narcissism, but also lead to more effective models for understanding personality pathology in general. A possible silver lining around the turmoil of this construct’s adolescence is that as the psychometric acne clears and measurement becomes more closely linked to developmental theory and phenomenology, narcissism might eventually become more widely regarded as an empirically mature and clinically respected form of psychopathology.
References Cain, N. M., Pincus, A. L., & Ansell, E. B. (2008). Narcissism at the crossroads: Phenotypic description of pathological narcissism across clinical theory, social/personality psychology, and psychiatric diagnosis.
449
Clinical Psychology Review, 28, 638 – 656. doi:10.1016/j.cpr.2007.09.006 Diamond, D., Levy, K. N., Clarkin, J. F., Fischer-Kern, M., Cain, N. M., Doering, S., . . . Buchheim, A. (2014). Attachment and mentalization in female patients with comorbid narcissistic and borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 5, 428 – 433. doi:10.1037/per0000065 Kohut, H. (1971). The analysis of the self. New York, NY: International Universities Press. Pincus, A. L., Cain, N. M., & Wright, A. G. C. (2014). Narcissistic grandiosity and narcissistic vulnerability in psychotherapy. Personality Disorders: Theory, Research, and Treatment, 5, 439 – 443. doi:10.1037/ per0000031 Ronningstam, E. (2014). Beyond the diagnostic traits: A collaborative exploratory diagnostic process for dimensions and underpinnings of narcissistic personality disorder. Personality Disorders: Theory, Research, and Treatment, 5, 434 – 438. doi:10.1037/per0000034 Roche, M. J., Pincus, A. L., Conroy, D. E., Hyde, A. L., & Ram, N. (2013). Pathological narcissism and interpersonal behavior in daily life. Personality Disorders: Theory, Research, and Treatment, 4, 315–323. doi:10.1037/ a0030798 Skodol, A. E., Bender, D. S., & Morey, L. C. (2014). Narcissistic personality disorder in DSM-5. Personality Disorders: Theory, Research, and Treatment, 5, 422– 427. doi:10.1037/per0000023
