Personality Disorders: Theory, Research, and Treatment 2014, Vol. 5, No. 4, 450 – 451
© 2014 American Psychological Association 1949-2715/14/$12.00 http://dx.doi.org/10.1037/per0000083
COMMENTARY
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.
Vulnerable Narcissism: Commentary for the Special Series “Narcissistic Personality Disorder—New Perspectives on Diagnosis and Treatment” Joshua D. Miller
Thomas A. Widiger
University of Georgia
University of Kentucky
W. Keith Campbell University of Georgia
that (a) are viewed as being most central to the disorder, and (b) demonstrate substantial discriminant validity (unlike vulnerable features, which are found in a wide array of both “Axis I and II” disorders). Third, clinical settings may not be the ideal place to study individuals with NPD, as this will invariably lead to a sample biased in the direction of vulnerability (given that it is these traits rather than grandiosity-related traits that typically motivate individuals to seek treatment; Pincus et al., 2009). This is apparent in the clinical vignettes presented in this Special Series in which the patients discussed manifested, in our opinion, only a small degree of grandiosity, especially compared with the much stronger, more pervasive presentation of vulnerability. Studying NPD primarily in the context of therapeutic settings is also problematic in that some data suggest that traits associated with NPD such as grandiosity, social dominance, risk taking, and callousness are found to a greater extent in community samples than clinical samples (e.g., Simms et al., 2013). In fact, it may be the atypical individual with NPD who seeks treatment. It is worth noting that NPD tends to covary substantially with antisocial and psychopathic personality disorders, neither of which is typically studied in clinical settings given their associations with externalizing rather than internalizing symptoms. Like these near-neighbor disorders, pathological narcissism might be more fruitfully examined in forensic and community settings.
We appreciate the chance to comment on the articles contained in this special issue on narcissistic personality disorder (NPD). The tie that binds these four articles together is the respective authors’ emphasis on the vulnerability— emotional, self-esteem/ego, interpersonal—that they consider to be central to pathological narcissism. We agree that it is important that the field acknowledge both grandiose and vulnerable aspects of narcissism (e.g., Miller & Campbell, 2008), but we wonder whether the pendulum is now swinging too far back in the direction of vulnerability.
The Role of Vulnerability in NPD First, we question the notion that narcissistic grandiosity and vulnerability “inevitably coexist” or even typically go together. Instead, the data suggest that the dimensions of narcissistic grandiosity and vulnerability are only modestly correlated and manifest unrelated nomological networks (e.g., Miller, Hoffman, et al., 2011); as such, it is likely that there are individuals who are only (or primarily) grandiose or only (or primarily) vulnerable, and more rarely individuals who have strong features of both (simultaneously or via oscillations). Empirical support for the existence of the latter type is weak (Bosson et al., 2008). Second, vulnerability is not a central component of narcissism according to most empirical accounts. Surveys of personality disorder researchers have shown that experts do not tend to characterize pathological narcissism/NPD using traits such as insecurity, self-consciousness, emotional lability, or vulnerability; instead, the traits deemed most relevant to prototypical cases of NPD are grandiosity, self-centeredness, callousness, entitlement, and manipulativeness (Donnellan, Ackerman, Hands, Hopwood, & Witt, 2014; Samuel, Lynam, Widiger, & Ball, 2012). The same picture emerges when using clinician ratings (Samuel & Widiger, 2004). Ultimately, it is the grandiose features of pathological narcissism
Conclusion The field has certainly benefitted from the trenchant observations made regarding pathological narcissism as a result of psychotherapeutic contact. Nevertheless, an overreliance on conceptualizations derived from clinical contexts has resulted in a potentially skewed conceptualization of NPD that emphasizes or prioritizes vulnerability over grandiosity. Moving forward, we believe the following: (a) The field would be better served if data from alternative populations were more regularly collected and integrated into the broader literature on pathological narcissism— populations in which there is reason to expect reasonably high levels of narcissism (e.g., samples from professional or forensic settings); (b) Grandiosity should be placed at the center of the conceptualization of NPD. Vulnerability may occur, but it is neither necessary nor sufficient to the presentation of pathological narcissism; (c) Empirical data are needed to determine whether
Joshua D. Miller, Department of Psychology, University of Georgia; Thomas A. Widiger, Department of Psychology, University of Kentucky; W. Keith Campbell, Department of Psychology, University of Georgia. Correspondence concerning this article should be addressed to Joshua D. Miller, Department of Psychology, University of Georgia, Athens, GA 30602-3013. E-mail: [email protected] 450
VULNERABLE NARCISSISM
pathologically narcissistic individuals oscillate between substantially grandiose and vulnerable states as some have hypothesized; (d) The best approach for diagnosing NPD is to consider grandiosity as the central component of the construct and include vulnerability as a diagnostic specifier for those cases where it is present (like the types presented in the vignettes; Miller, Gentile, Wilson, & Campbell, 2013).
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.
References Bosson, J. K., Lakey, C. E., Campbell, W. K., Zeigler-Hill, V., Jordan, C. H., & Kernis, M. H. (2008). Untangling the links between narcissism and self-esteem: A theoretical and empirical review. Social and Personality Psychology Compass, 2, 1415–1439. doi:10.1111/j.1751-9004 .2008.00089.x Donnellan, M. B., Ackerman, R. A., Hands, A., Hopwood, C., & Witt, E. A. (2014, February). Assessing narcissistic personality attributes: Current controversies and future directions. Poster presented at the Society for Personality and Social Psychology, Austin, TX. Miller, J. D., & Campbell, W. K. (2008). Comparing clinical and socialpersonality conceptualizations of narcissism. Journal of Personality, 76, 449 – 476. doi:10.1111/j.1467-6494.2008.00492.x
451
Miller, J. D., Gentile, B., Wilson, L., & Campbell, W. K. (2013). Grandiose and vulnerable narcissism and the DSM-5 pathological personality trait model. Journal of Personality Assessment, 95, 284 –290. doi:10.1080/ 00223891.2012.685907 Miller, J. D., Hoffman, B. J., Gaughan, E. T., Gentile, B., Maples, J., & Campbell, W. K. (2011). Grandiose and vulnerable narcissism: A nomological network analysis. Journal of Personality, 79, 1013–1042. doi:10.1111/j.1467-6494.2010.00711.x Pincus, A. L., Ansell, E. B., Pimentel, C. A., Cain, N. M., Wright, A., & Levy, K. N. (2009). Initial construction and validation of the Pathological Narcissism Inventory. Psychological Assessment, 21, 365–379. doi: 10.1037/a0016530 Samuel, D. B., Lynam, D. R., Widiger, T. A., & Ball, S. A. (2012). An expert consensus approach to relating the proposed DSM-5 types and traits. Personality Disorders: Theory, Research, and Treatment, 3, 1–16. doi:10.1037/a0023787 Samuel, D. B., & Widiger, T. A. (2004). Clinicians’ personality descriptions of prototypic personality disorders. Journal of Personality Disorders, 18, 286 –308. doi:10.1521/pedi.18.3.286.35446 Simms, L. J., Goldberg, L. R., Watson, D., Roberts, J., & Welte, J. (2013, September). The CAT-PD project: Introducing an integrative model and efficient measure of personality disorder traits. Paper presented at the annual meeting of the Society for Research in Psychopathology, Oakland, CA.
© 2014 American Psychological Association 1949-2715/14/$12.00 http://dx.doi.org/10.1037/per0000083
COMMENTARY
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.
Vulnerable Narcissism: Commentary for the Special Series “Narcissistic Personality Disorder—New Perspectives on Diagnosis and Treatment” Joshua D. Miller
Thomas A. Widiger
University of Georgia
University of Kentucky
W. Keith Campbell University of Georgia
that (a) are viewed as being most central to the disorder, and (b) demonstrate substantial discriminant validity (unlike vulnerable features, which are found in a wide array of both “Axis I and II” disorders). Third, clinical settings may not be the ideal place to study individuals with NPD, as this will invariably lead to a sample biased in the direction of vulnerability (given that it is these traits rather than grandiosity-related traits that typically motivate individuals to seek treatment; Pincus et al., 2009). This is apparent in the clinical vignettes presented in this Special Series in which the patients discussed manifested, in our opinion, only a small degree of grandiosity, especially compared with the much stronger, more pervasive presentation of vulnerability. Studying NPD primarily in the context of therapeutic settings is also problematic in that some data suggest that traits associated with NPD such as grandiosity, social dominance, risk taking, and callousness are found to a greater extent in community samples than clinical samples (e.g., Simms et al., 2013). In fact, it may be the atypical individual with NPD who seeks treatment. It is worth noting that NPD tends to covary substantially with antisocial and psychopathic personality disorders, neither of which is typically studied in clinical settings given their associations with externalizing rather than internalizing symptoms. Like these near-neighbor disorders, pathological narcissism might be more fruitfully examined in forensic and community settings.
We appreciate the chance to comment on the articles contained in this special issue on narcissistic personality disorder (NPD). The tie that binds these four articles together is the respective authors’ emphasis on the vulnerability— emotional, self-esteem/ego, interpersonal—that they consider to be central to pathological narcissism. We agree that it is important that the field acknowledge both grandiose and vulnerable aspects of narcissism (e.g., Miller & Campbell, 2008), but we wonder whether the pendulum is now swinging too far back in the direction of vulnerability.
The Role of Vulnerability in NPD First, we question the notion that narcissistic grandiosity and vulnerability “inevitably coexist” or even typically go together. Instead, the data suggest that the dimensions of narcissistic grandiosity and vulnerability are only modestly correlated and manifest unrelated nomological networks (e.g., Miller, Hoffman, et al., 2011); as such, it is likely that there are individuals who are only (or primarily) grandiose or only (or primarily) vulnerable, and more rarely individuals who have strong features of both (simultaneously or via oscillations). Empirical support for the existence of the latter type is weak (Bosson et al., 2008). Second, vulnerability is not a central component of narcissism according to most empirical accounts. Surveys of personality disorder researchers have shown that experts do not tend to characterize pathological narcissism/NPD using traits such as insecurity, self-consciousness, emotional lability, or vulnerability; instead, the traits deemed most relevant to prototypical cases of NPD are grandiosity, self-centeredness, callousness, entitlement, and manipulativeness (Donnellan, Ackerman, Hands, Hopwood, & Witt, 2014; Samuel, Lynam, Widiger, & Ball, 2012). The same picture emerges when using clinician ratings (Samuel & Widiger, 2004). Ultimately, it is the grandiose features of pathological narcissism
Conclusion The field has certainly benefitted from the trenchant observations made regarding pathological narcissism as a result of psychotherapeutic contact. Nevertheless, an overreliance on conceptualizations derived from clinical contexts has resulted in a potentially skewed conceptualization of NPD that emphasizes or prioritizes vulnerability over grandiosity. Moving forward, we believe the following: (a) The field would be better served if data from alternative populations were more regularly collected and integrated into the broader literature on pathological narcissism— populations in which there is reason to expect reasonably high levels of narcissism (e.g., samples from professional or forensic settings); (b) Grandiosity should be placed at the center of the conceptualization of NPD. Vulnerability may occur, but it is neither necessary nor sufficient to the presentation of pathological narcissism; (c) Empirical data are needed to determine whether
Joshua D. Miller, Department of Psychology, University of Georgia; Thomas A. Widiger, Department of Psychology, University of Kentucky; W. Keith Campbell, Department of Psychology, University of Georgia. Correspondence concerning this article should be addressed to Joshua D. Miller, Department of Psychology, University of Georgia, Athens, GA 30602-3013. E-mail: [email protected] 450
VULNERABLE NARCISSISM
pathologically narcissistic individuals oscillate between substantially grandiose and vulnerable states as some have hypothesized; (d) The best approach for diagnosing NPD is to consider grandiosity as the central component of the construct and include vulnerability as a diagnostic specifier for those cases where it is present (like the types presented in the vignettes; Miller, Gentile, Wilson, & Campbell, 2013).
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.
References Bosson, J. K., Lakey, C. E., Campbell, W. K., Zeigler-Hill, V., Jordan, C. H., & Kernis, M. H. (2008). Untangling the links between narcissism and self-esteem: A theoretical and empirical review. Social and Personality Psychology Compass, 2, 1415–1439. doi:10.1111/j.1751-9004 .2008.00089.x Donnellan, M. B., Ackerman, R. A., Hands, A., Hopwood, C., & Witt, E. A. (2014, February). Assessing narcissistic personality attributes: Current controversies and future directions. Poster presented at the Society for Personality and Social Psychology, Austin, TX. Miller, J. D., & Campbell, W. K. (2008). Comparing clinical and socialpersonality conceptualizations of narcissism. Journal of Personality, 76, 449 – 476. doi:10.1111/j.1467-6494.2008.00492.x
451
Miller, J. D., Gentile, B., Wilson, L., & Campbell, W. K. (2013). Grandiose and vulnerable narcissism and the DSM-5 pathological personality trait model. Journal of Personality Assessment, 95, 284 –290. doi:10.1080/ 00223891.2012.685907 Miller, J. D., Hoffman, B. J., Gaughan, E. T., Gentile, B., Maples, J., & Campbell, W. K. (2011). Grandiose and vulnerable narcissism: A nomological network analysis. Journal of Personality, 79, 1013–1042. doi:10.1111/j.1467-6494.2010.00711.x Pincus, A. L., Ansell, E. B., Pimentel, C. A., Cain, N. M., Wright, A., & Levy, K. N. (2009). Initial construction and validation of the Pathological Narcissism Inventory. Psychological Assessment, 21, 365–379. doi: 10.1037/a0016530 Samuel, D. B., Lynam, D. R., Widiger, T. A., & Ball, S. A. (2012). An expert consensus approach to relating the proposed DSM-5 types and traits. Personality Disorders: Theory, Research, and Treatment, 3, 1–16. doi:10.1037/a0023787 Samuel, D. B., & Widiger, T. A. (2004). Clinicians’ personality descriptions of prototypic personality disorders. Journal of Personality Disorders, 18, 286 –308. doi:10.1521/pedi.18.3.286.35446 Simms, L. J., Goldberg, L. R., Watson, D., Roberts, J., & Welte, J. (2013, September). The CAT-PD project: Introducing an integrative model and efficient measure of personality disorder traits. Paper presented at the annual meeting of the Society for Research in Psychopathology, Oakland, CA.
