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Brain structure in narcissistic personality disorder: A VBM and DTI pilot study
... Research on the neural correlates of narcissism focus largely on subclinical grandiose narcissism using the NPI [3][4][5][6][7][8], while a few studies have used fMRI to examine the brains of patients with NPD [9,10]. Some studies have also investigated NPD by employing the use of DTI in both volumetric and resting state [11,12]. ...
... The neural correlates of self-awareness have been determined to be rooted in the medial prefrontal cortex (mPFC), as the mPFC is involved in self-reflective thought, projection of the self into the future, and self-regulation in social settings [37]. Studies have determined that the right dorsolateral prefrontal cortex and bilateral medial prefrontal areas, which are related to a lack of control over emotional and social interactions, may also play a role [5,8,9,12,39,40]. Even though concrete evidence linking desire for fame to these brain areas has not yet been obtained, the relationships between narcissism, desire for fame, and self-awareness seem to point to the frontal regions of the brain as possible neural correlates. ...
... It has been determined that narcissism, desire for fame, and celebrity worship are related on a behavioral level [16][17][18][19]; however, here, we attempt to determine if they could be related on a neural level as well. These three deviations of the self have been associated with the frontal regions of the brain, including the medial prefrontal cortex [5,6,10,12,39] and the right dorsolateral prefrontal cortex [5,8,9,12,39]. Even though neurological studies are in their infancy, the relevant data suggest a common neural pathway that involves the interplay of empathy [6,10,47] and self-awareness [9,10,37,45] in the frontal regions of the brain. ...
(1) Objective: Narcissism is characterized by emotional regulation deficits, a lack of empathy for others, and extreme self-focus. Narcissism has also been linked to an increased desire for fame and celebrity worship. Here, the neuroscience underlying narcissism is examined in order to determine what regions and networks of the brain are altered when non-narcissistic individuals are compared to participants with both grandiose and vulnerable narcissism. (2) Methods: The behavioral relationships between grandiose narcissism and desire for fame and vulnerable narcissism and celebrity worship are explored, along with a possible relationship at the neural level between these constructs. In this paper, we review research demonstrating that increased levels of grandiose narcissism are associated with an increase in obsession with fame, while vulnerable narcissism is associated with celebrity worship. (3) Results: Based on current data, the frontal regions underlie narcissism and also likely underlie celebrity worship and desire for fame. This tenuous conclusion is based on a limited number of studies. (4) Conclusions: The brain areas associated with grandiose narcissism may be associated with an intense desire for fame as well, while brain regions associated with vulnerable narcissism may be similar in celebrity worshipers. Future research studies on the brain that are specifically designed to test these relationships at a neurological level are needed.
... Potenza et al. (2003) reported decreased left vmPFC/OFC activity in pathological gamblers with impulsivity problems and Jollant et al. (2010) found that suicide attempters who often had high impulsivity had reduced activation during risky decision-making in the left OFC. Furthermore, Nenadic et al. (2015) found reduced GM in the right prefrontal and bilateral medial prefrontal/anterior cingulate cortices in patients with narcissistic personality disorder. Taken together, evidence has suggested that abnormalities in the right OFC are related to higher levels of callous-unemotional traits and narcissism (Nenadic et al., 2015;Tranel et al., 2002), whereas deficits in the left OFC are related to more impulsivity problems (Potenza et al., 2003). ...
... Furthermore, Nenadic et al. (2015) found reduced GM in the right prefrontal and bilateral medial prefrontal/anterior cingulate cortices in patients with narcissistic personality disorder. Taken together, evidence has suggested that abnormalities in the right OFC are related to higher levels of callous-unemotional traits and narcissism (Nenadic et al., 2015;Tranel et al., 2002), whereas deficits in the left OFC are related to more impulsivity problems (Potenza et al., 2003). ...
... It was hypothesized that the dimensions of psychopathic traits would be differentially associated with structural abnormalities in specific parts of the OFC (lateral vs. medial parts). Based on prior findings (e.g., Nenadic et al., 2015;Potenza et al., 2003;Tranel et al., 2002), it was hypothesized that callous-unemotional and narcissistic traits would be associated with right-left asymmetries in the mOFC (smaller GM volumes in the right as compared to the left mOFC), and that impulsivity would be associated with left-right asymmetries in the mOFC (smaller GM volumes in the left as compared to the right mOFC). In contrast, it was hypothesized that the GM volumes asymmetries in the lOFC would not be associated with any psychopathic traits. ...
Background
Structural abnormalities in the orbitofrontal cortex (OFC) of incarcerated psychopaths have been well documented. However, the neural correlates of psychopathic traits in younger and nonclinical samples remain poorly understood.
Aim
The present study aimed to examine the structural brain asymmetry in the OFC in relation to dimensions of psychopathic traits in adolescents from the community.
Method
In 29 youths from the community, childhood psychopathic traits including narcissism, impulsivity, and callous-unemotional traits were assessed when they were 7- to 10 years old (Time 1), and their gray matter (GM) volumes were measured using structural Magnetic Resonance Imaging when they were 10- to 14 years old (Time 2).
Results
After controlling for age, sex, IQ, pubertal stage, and whole-brain volumes, callous-unemotional traits were associated with right-left asymmetry in the medial OFC (mOFC), that is, smaller right mOFC GM as compared to the left. Impulsivity was associated with left-right asymmetry in the mOFC, that is, smaller left mOFC than the right. Narcissism was not associated with any GM asymmetry measure. No significant association was found for the lateral OFC, amygdala, caudate and putamen.
Conclusion
The present findings provide further support that dimensions of psychopathic traits may have distinct neurobiological correlates.
... Likewise, aberrant amygdala and medial frontal cortex (mPFC) functioning has been thought to contribute to emotional processing deficits among narcissistic personality disorder (Ronningstam & Baskin-Sommers, 2013). Lastly, narcissism was linked to structural changes in regions important in emotion regulation, selfprocessing, empathy, and theory of mind, including the dorsolateral prefrontal cortex (dlPFC), mPFC, dACC, and AI (Mao et al., 2016;Nenadic et al., 2015;Schulze et al., 2013). Taken together, recent neuroscientific findings are in line with diverse manifestations of narcissism in multiple neuropsychological functions. ...
... Second, the RSFC allows for examining interplay between neural systems that are associated with trait narcissism (Braun et al., 2018). The functional connectivity across large-scale neural networks may play critical roles in maintaining trait narcissism, because narcissism is a complex and multidimensional construct and might be rooted in the functional and structural integrity of distributed networks Morf & Rhodewalt, 2001;Nenadic et al., 2015;Yang et al., 2015). RSFC has emerged as a powerful network-level approach to significantly advance our understanding of individual differences in human cognitive ability and personality traits. ...
... For instance, the amygdala and prefrontal regions have been thought to play crucial roles in mediating fear and self-regulatory deficits among narcissism personality disorders (Ronningstam & Baskin-Sommers, 2013). Moreover, narcissistic personality disorder patients compared to healthy controls exhibited grey and white matter deficits in key nodes observed in the current study, including lateral PFC and mPFC/dACC (Nenadic et al., 2015). Lastly, narcissistic personality disorder patients often exhibit deficiencies in emotional processing and empathic functioning that are associated with brain networks identified in the current study (Ronningstam, 2016;Ronningstam, 2017). ...
Narcissism is one of the most fundamental personality traits in which individuals in general population exhibit a large heterogeneity. Despite a surge of interest in examining behavioral characteristics of narcissism in the past decades, the neurobiological substrates underlying narcissism remain poorly understood. Here, we addressed this issue by applying a machine learning approach to decode trait narcissism from whole‐brain resting‐state functional connectivity (RSFC). Resting‐state functional MRI (fMRI) data were acquired for a large sample comprising 155 healthy adults, each of whom was assessed for trait narcissism. Using a linear prediction model, we examined the relationship between whole‐brain RSFC and trait narcissism. We demonstrated that the machine‐learning model was able to decode individual trait narcissism from RSFC across multiple neural systems, including functional connectivity between and within limbic and prefrontal systems as well as their connectivity with other networks. Key nodes that contributed to the prediction model included the amygdala, prefrontal and anterior cingulate regions that have been linked to trait narcissism. These findings remained robust using different validation procedures. Our findings thus demonstrate that RSFC among multiple neural systems predicts trait narcissism at the individual level.
... This possible link between empathy and neurobiological abnormality in the left anterior insula, in line with findings in healthy individuals [148], was supported at the trend level in the study by Schulze et al. [110]. On the other hand, Nenadic et al. [111] used both voxel-based morphometry and DTI in narcissistic personality disorder patients and healthy volunteers. They found that the grey matter variations in narcissistic patients were concentrated in the right prefrontal and bilateral medial prefrontal areas, in line with the findings of Schulze et al. [110]. ...
... They found that the grey matter variations in narcissistic patients were concentrated in the right prefrontal and bilateral medial prefrontal areas, in line with the findings of Schulze et al. [110]. Nevertheless no significant difference in the insular cortex was identified, probably due to the small sample size in the study of Nenadic et al. [111]. The DTI findings complemented the grey matter findings, revealing lower activity in the right frontal lobe, right anterior thalamic radiation, right anterior temporal lobe, left anterior/lateral temporal lobe, and right brain stem of patients with narcissistic personality disorder [111]. ...
... Nevertheless no significant difference in the insular cortex was identified, probably due to the small sample size in the study of Nenadic et al. [111]. The DTI findings complemented the grey matter findings, revealing lower activity in the right frontal lobe, right anterior thalamic radiation, right anterior temporal lobe, left anterior/lateral temporal lobe, and right brain stem of patients with narcissistic personality disorder [111]. Critical neuroimaging findings on this disorder are summarized in Table 2. ...
Personality disorders often act as a common denominator for many psychiatric problems, and studies on personality disorders contribute to the etiopathology, diagnosis, and treatment of many mental disorders. In recent years, increasing evidence from various studies has shown distinctive features of personality disorders, and that from genetic and neuroimaging studies has been especially valuable. Genetic studies primarily target the genes encoding neurotransmitters and enzymes in the serotoninergic and dopaminergic systems, and neuroimaging studies mainly focus on the frontal and temporal lobes as well as the limbic-paralimbic system in patients with personality disorders. Although some studies have suffered due to unclear diagnoses of personality disorders and some have included few patients for a given personality disorder, great opportunities remain for investigators to launch new ideas and technologies in the field.
... The other regions also overlap with those commonly implicated in empathy (Lamm et al., 2011), which, taken together, corroborates the notion of reduced empathic functioning in NPD at the level of brain structure. A subsequent study compared gray matter volume in six male NPD patients to controls (Nenadic et al., 2015). Lower gray matter volume was found in the right middle frontal gyrus, left medial prefrontal/anterior cingulate cortex, left middle occipital cortex, left fusiform/inferior temporal cortex, right superior temporal cortex, and in the left lingual gyrus. ...
... This evidence rather exclusively points to dysfunctional aspects of narcissism in terms of reduced neuronal integrity. To this end, the most consistent finding across the existing studies seems to be lowered gray matter volume in the mPFC (Mao et al., 2016;Nenadic et al., 2015;Schulze et al., 2013). ...
Narcissism is a Janusian personality construct, associated with both grandiose self-assuredness and dominance, as well as vulnerable insecurity and reactivity. Central questions of intra-and interpersonal functioning in narcissism are still a matter of debate. Neuroscience could help to understand the paradoxical patterns of experience and behavior beyond the limitations of self-reports. We provide a systematic review of 34 neuroscience studies on grandiose, vulnerable, pathological narcissism, and Narcissistic Personality Disorder (NPD), spanning experimental investigations of intra-and interpersonal mechanisms, research on neurophysiological and neuroendocrine aspects of baseline function, and brain structural correlates. While neurosci-ence has scarcely directly studied vulnerable narcissism, grandiose narcissism is associated with heightened vigilance to ego threat and stress responses following ego threat, as well as heightened stress indicators in baseline measures. Such responses are not commonly observed in self-reports, highlighting the potential of neuroscience to augment our understanding of self-regulatory dynamics in narcissism. Interpersonal functioning is characterized by deficits in social-affective processes. Both involve altered activity within the salience network, pointing to a double dissociation regarding the expression of narcissism and self/other oriented situa-tional focus. Findings are summarized in an integrative model providing testable hypotheses for future research along with methodological recommendations.
... Spominje se i povezanost narcističkih osobina s desnom prednjom inzulom (engl. right anterior insula) (7,8). ...
... Neuroscientific research in persons suffering from narcissistic personality disorder has found a deficit in gray matter in the right prefrontal and bilateral medial prefrontal/anterior cingulate cortices, as well as reduced fractional anisotropy in the white matter of the right frontal lobe. There have also been reports of an association between narcissistic traits and the right anterior insula (7,8) Narcissism is often accompanied by a feeling of entitlement -a feeling that the person is entitled to anything and that the world is in their debt due to the mere fact of their existence. Furthermore, such persons are obsessed with perfectionism that stems from a very strict, punishing superego. ...
Narcissism is a growing issue in modern society. Society values external, objective successfulness, overindulgence in hedonism, and superficiality more than inner emotional life. Individuals in modern society are faced with an inner emptiness, resulting in narcissistic, grandiose fantasies sometimes being the last defensive mechanism against that painful confrontation. Persons with borderline disorder are envious because they lack the strength of the narcissists, causing them to feel even more empty and powerless. When there is trauma and guilt between two groups of people, it is hard to deal with the issues directly and it is easier to take a narcissistic position projecting everything that is negative onto a person with borderline disorder. This creates a hot-and-cold relationship that constantly replays itself. This brings us to the social aspects of the relationship between narcissistic and borderline personality disorder, which is the topic of this article. Creating an environment and culture of forgiveness is a difficult, but not impossible path. It consists of healthy mourning, sublimating aggression, and encouraging good experiences and new interests. Additionally, it is important to encourage socialization and dialogue because this is the only way to achieve the empathy and altruism that we are trying to evoke and which lead to a better relationship.
... Although BPD patients tend to make more and faster initial eye fixations to the eyes of angry faces (58) and tend to misclassify predominantly happy faces as angry faces (56) Reduced gray matter volume in patients with NPD was found in the anterior insula, rostral ACC, mPFC and median cingulate (67). Another study found reduced gray matter volume in mPFC/ACC, fusiform, temporal and occipital cortices (68). ...
... Higher anterior insula volume predicted higher emotional empathy (67). These findings were further supported by diffusion tensor imaging findings, showing altered structural connectivity involving frontal lobe and thalamic regions (68). Neural alterations were discussed to underly decreased empathy which is characteristic for NPD (67). ...
Altered processing of emotion, cognition, social interactions, and behavioural responding is characteristic for personality disorders. Neuroimaging has contributed to a better understanding of biological markers of inflexible and maladaptive behaviours prevalent in personality disorders. This chapter summarizes results from magnetic resonance imaging and electroencephalography studies, with a focus on research in borderline personality disorder (BPD). Knowledge on neural processes underlying emotion processing and emotion regulation has significantly advanced. Overall, findings corroborate dysfunctions in limbic–prefrontal networks, emphasizing hyper-responsiveness of the amygdala and a lack of prefrontal control. Neuroimaging studies addressed several domains of cognitive functions in BPD and shed light on the processing of social information in the brain. Though profound achievements have been made, comprehensive neurobiological models addressing behavioural dysregulation, impulsivity, and abnormal social interaction in BPD are still pending.
... a few studies yield interesting data on the association between narcissism, self-esteem, and grandiosity. As mentioned above, structural abnormalities have been found in NPD patients in the mPFC (Nenadic et al. 2015). The mPFC activity has been associated with sensitivity to the self-relevance of stimuli (Denny et al. 2012), and has also been related to cognitive control and performance monitoring (Krusemark et al. 2008). ...
... The activity of the mPfc has been negatively related to self-serving attributions in experimental procedures. in particular, an eeg study found that non self-serving attributions required increased activity in the mPfc -interpreted as a sign of heightened self-controlwhen compared to self-serving attributions in healthy participants (Krusemark et al. 2008). Abnormalities in the mPFC found in narcissists (Nenadic et al. 2015) may therefore be the source of their self-enhancing tendencies. Striking support to this hypothesis comes from the investigation of the connections between mPfc and basal ganglia. ...
During the last decades, empirical interest in narcissism has steeply increased, leading to controversial findings. Its investigation has been conducted predominantly with self-report measures, which could distort empirical findings on narcissism and its correlates due to narcissists’ need to maintain a positive and inflated self-view. In the present work,
we summarize studies that use alternative research designs for the investigation of narcissism. First, we briefly describe studies examining psychophysiological correlates of narcissistic phenomena, such as hostility, empathic dysfunctions, and stress sensitivity. Then, we review current literature on the investigation of narcissism in a neuroscientific
perspective, both in clinical and non clinical samples. Because studies in this field are very recent, we focus on those brain regions whose involvement in narcissistic functioning has received by now the strongest empirical support. In particular, we underline the role of the anterior insula and of the pre-frontal regions, discussing their implications in narcissistic dysfunctions, such as empathy deficits, emotion dysregulation, heightened sensitivity to rejection, and self-enhancing tendencies. Rather than considering brain activity as the cause of narcissism, our aim is to highlight the
importance of personality neuroscience for the development of a more complete view over narcissism, due to the ability of brain research to dig into the emotional and cognitive mechanisms underlying personality functioning.
... Furthermore, previous studies on white matter (WM) contribution to narcissistic personality have examined fibre tract integrity using diffusion-tensor imaging (DTI), a magnetic resonance imaging (MRI) technique that quantifies diffusion properties in WM (Assaf & Pasternak, 2008). Nenadic et al. (2015) reported, in a clinical sample, a decreased fractional anisotropy (FA, an index of WM integrity) in the right frontal and temporal lobe, right anterior thalamic radiation and the right brain stem. Chester et al. (2016) also observed an association between narcissism and reduced WM integrity in frontostriatal pathways. ...
Despite the clinical significance of narcissistic personality, its neural bases have not been clarified yet, primarily because of methodological limitations of the previous studies, such as the low sample size, the use of univariate techniques and the focus on only one brain modality. In this study, we employed for the first time a combination of unsupervised and supervised machine learning methods, to identify the joint contributions of grey matter (GM) and white matter (WM) to narcissistic personality traits (NPT). After preprocessing, the brain scans of 135 participants were decomposed into eight independent networks of covarying GM and WM via parallel ICA. Subsequently, stepwise regression and Random Forest were used to predict NPT. We hypothesized that a fronto-temporo parietal network, mainly related to the default mode network, may be involved in NPT and associated WM regions. Results demonstrated a distributed network that included GM alterations in fronto-temporal regions, the insula and the cingulate cortex, along with WM alterations in cerebellar and thalamic regions. To assess the specificity of our findings, we also examined whether the brain network predicting narcissism could also predict other personality traits (i.e., histrionic, paranoid and avoidant personalities). Notably, this network did not predict such personality traits. Additionally, a supervised machine learning model (Random Forest) was used to extract a predictive model for generalization to new cases. Results confirmed that the same network could predict new cases. These findings hold promise for advancing our understanding of personality traits and potentially uncovering brain biomarkers associated with narcissism.
... The results of this research were in line with the research by Fatehizadeh et al. (2016) in Isfahan metropolis, and also the research by Farnoosh et al. (2007) in Tehran. Narcissistic personality disorder (NPD) is usually characterized by an absence of empathy for others, and also fickle and brittle selfesteem, which makes peoples with NPD seek attention and approval (Esmaeilian et al., 2022;Nenadic et al., 2015). The prevalence of NPD in the population ranged from 0% to 6.2%, and 50% to 75% of the affected individuals were males (Schulze et al., 2013). ...
Background: Personality disorder is a type of mental disorder in which a rigid and unhealthy pattern of thinking, functioning, and behaving may be seen. A person with a personality disorder has trouble perceiving and relating to situations and people. Limited research has been done on the prevalence of personality disorders in Iran. This study aims at investigating the prevalence of personality disorders among males and females between the ages 15 and 65 in Yazd, Iran. Methods: The dataset for this cross-sectional study was extracted from a dataset of a national survey conducted on personality disorders of Iranians. The contents relevant to Yazd City were included here with a sample of 1827 people. Among the participants, 852 males and 975 females answered the personality disorders questionnaire (MILON). Results: Findings indicated that except histrionic and narcissistic patterns, the high rate of the rest of patterns was greater among females, which indicated that in most cases females significantly suffered higher clinical-related personality disorders. Moreover, personality disorders were more prevalent among females (29.8) compared to males (24.3). Conclusion: This area requires extensive investigation. More evidence is needed regarding the differential impact of personality disorders regarding men and women in other areas of Iran.
... 42 Además, el narcisismo se asoció con una mayor actividad de la red de dolor social, en la experiencia emocional desagradable al percibir que el individuo es excluido o rechazado por parte de personas o grupos con los que desea relacionarse; del mismo modo, se ha pensado que el funcionamiento aberrante de la amígdala y la corteza frontal medial contribuye a los déficits de procesamiento emocional en este trastorno; 43,44 relacionándose con cambios estructurales en regiones importantes incluyendo la corteza prefrontal dorsolateral (dlPFC), corteza prefrontal medial (mPFC), corteza cingulada anterior dorsal (dACC). 39,45,46 Como posible criterio diagnóstico, neuropsicólogos y neurofisiólogos están definiendo a la activación en la corteza cingulada anterior dorsal y ventral (dACC/vACC), regiones asociadas con el afecto negativo o el conflicto emocional, 47 sin embargo, aún no son datos diagnósticos concluyentes. ...
Día con día nos exponemos a obstáculos y desafíos para obtener así un beneficio; el narcisismo patológico implica importantes déficits en la calidad de vida y estrategias de mala adaptación al momento de hacer frente a decepciones o amenazas a la imagen positiva de sí mismo. El narcisismo y trastorno de personalidad narcisista se han descrito desde el psicoanálisis en 1898, el mito griego de Narciso, la filosofía del yo, y los libros de psiquiatría de la actualidad; sin embargo, su diagnóstico y tratamiento se han visto cegados por una escasa importancia al tema y su estudio. Se dice que todos los individuos pueden presentar un narcisismo normal; sin embargo, los individuos patológicamente narcisistas usualmente se preocupan o defraudan, e incluso se sienten amenazados ante las situaciones o personas que se presentan en su vida. Esta patología incide en la calidad de vida de quienes la padecen y de quienes los rodean, de ahí la importancia de conocerla.
... 42 Además, el narcisismo se asoció con una mayor actividad de la red de dolor social, en la experiencia emocional desagradable al percibir que el individuo es excluido o rechazado por parte de personas o grupos con los que desea relacionarse; del mismo modo, se ha pensado que el funcionamiento aberrante de la amígdala y la corteza frontal medial contribuye a los déficits de procesamiento emocional en este trastorno; 43,44 relacionándose con cambios estructurales en regiones importantes incluyendo la corteza prefrontal dorsolateral (dlPFC), corteza prefrontal medial (mPFC), corteza cingulada anterior dorsal (dACC). 39,45,46 Como posible criterio diagnóstico, neuropsicólogos y neurofisiólogos están definiendo a la activación en la corteza cingulada anterior dorsal y ventral (dACC/vACC), regiones asociadas con el afecto negativo o el conflicto emocional, 47 sin embargo, aún no son datos diagnósticos concluyentes. ...
Día con día nos exponemos a obstáculos y desafíos para obtener así un beneficio; el narcisismo patológico implica importantes déficits en la calidad de vida y estrategias de mala adaptación al momento de hacer frente a decepciones o amenazas a la imagen positiva de sí mismo. El narcisismo y trastorno de personalidad narcisista se han descrito desde el psicoanálisis en 1898, el mito griego de Narciso, la filosofía del yo, y los libros de psiquiatría de la actualidad; sin embargo, su diagnóstico y tratamiento se han visto cegados por una escasa importancia al tema y su estudio. Se dice que todos los individuos pueden presentar un narcisismo normal; sin embargo, los individuos patológicamente narcisistas usualmente se preocupan o defraudan, e incluso se sienten amenazados ante las situaciones o personas que se presentan en su vida. Esta patología incide en la calidad de vida de quienes la padecen y de quienes los rodean, de ahí la importancia de conocerla.
... Consistent with these findings, another group of investigators found that NPD patients generally performed worse on a facial emotion recognition task compared to controls (Marissen et al., 2012). Finally, there is emerging neurobiological evidence linking NPD to abnormalities in brain regions associated with empathic functioning (Nenadic et al., 2015;Schulze et al., 2013). ...
... In contrast to other personality dimensions, such as the borderline personality disorder phenotype, which includes neurocognitively relevant aspects of impulsivity (overlapping with attention-deficit disorders) and behavioural dysregulation (Sebastian et al., 2014) as well as neurobiologically established alterations (Davies et al., 2020;Grottaroli et al., 2020), there is no clearly delineated neural model for narcissism. While some studies have pointed to anterior insula grey matter reduction in NaPD (Schulze et al., 2013), some minor reductions also seem to be present in medial or lateral prefrontal areas (Schulze et al., 2013;Nenadic et al., 2015a), which are relevant for executive functions. Indeed, two mentioned studies in non-clinical subjects show a correlation with prefrontal cortical volumes (Mao et al., 2016) and prefronto-parietal functioning (Yang et al., 2015), respectively. ...
Several personality disorders have been associated with cognitive impairment, including executive functions like working memory. Yet, it is unclear whether subclinical expression in non-clinical persons is associated with cognitive functioning. Recent studies indicate that non-clinical subjects might, in fact, perform better with increasing moderate to mild expressions of narcissistic features. We tested working memory performance in a cohort of n=70 psychiatrically and neurologically healthy subjects using Wechsler Adult Intelligence Scale (WAIS/WIE) subtests Arithmetic, Digit Span and Letter-Number Sequencing, and assessed narcissistic features using three different inventories: the widely used Narcissistic Personality Inventory (NPI), as well as two clinically used measures of narcissistic traits and states, respectively, derived from schema-focused therapy, i.e., the Young Schema Questionnaire (YSQ) entitlement/grandiosity subscale and the Schema Mode Inventory (SMI) self-aggrandizer subscale. In accordance with our hypothesis, we found nominally significant positive correlations of WIE Arithmetic performance with NPI total score (Spearman’s rho=0.208; p=0.043) and SMI self-aggrandizer scale (Spearman’s rho=0.231; p=0.027), but findings did not survive false discovery rate (FDR) adjustment for multiple comparisons (pFDR=0.189 and pFDR=0.243, respectively). While our findings add to recent studies on cognitive performance in subclinical narcissism, they fail to demonstrate an association of cognitive performance with narcissistic traits across multiple working memory tests, indicating the need for additional study, including complementary executive functions in larger cohorts and ranges of phenotype expression.
... Although numerous studies have linked narcissism to the frontal cortex (e.g., Mao et al., 2016;Nenadic et al., 2015), one study has directly examined the brain, self-faces, and narcissism. Men who reported higher narcissistic traits demonstrated greater brain activation in brain regions, including the dorsal and ventral anterior cingulate cortex. ...
Though debated, it has been argued that self-face recognition is an indicator of consciousness of self typically called self-awareness. Evidence from behavioral and neuronal studies suggests that self-recognition is associated with activation in the right prefrontal cortex (PFC). Although previous studies have examined neurological correlates of deficits in self-recognition (e.g., autism, schizophrenia), the current study attempted to examine neurological correlates of inflated self-focus. Thus, this study used transcranial magnetic stimulation to assess neurological correlates of self-recognition in different regions of the PFC and to assess whether narcissistic personality traits would be correlated with reaction time (RT) among 11 healthy participants. It was found that RT for self-face identification was positively correlated with narcissistic personality traits (p = .034). It was also found that the interaction between brain region and RT for self-faces was significant after narcissism was controlled for, demonstrating an association between narcissistic traits and self-recognition (p = .036). The results support previous research indicating the right PFC is necessary for self-face recognition. Furthermore, increases in narcissistic traits decreased self-recognition RT, and self-recognition appeared to be mediated via right PFC regions.
... In addition to functional alterations and grey matter volume differences, impairment of white matter (WM) structures has been linked to cognitive and behavioural alterations in PTSD (O'Doherty et al., 2018). Indeed, similar cluster B personality disorders -including: antisocial (Jiang et al., 2017), schizotypal (Sun et al., 2016) and narcissistic (Nenadic et al., 2015) personality disorders-exhibit WM abnormalities. Given its potential efficaciousness on cognition and behaviour, it is important to analyse if WM abnormalities are also present in individuals with BorPD. ...
Borderline personality disorder (BorPD) is characterized by instability and mood dysregulation, unstable relationships and distorted self-image. Identification of underlying anatomical and physiological changes is crucial to refine current treatments and develop new ones. In this perspective, previous magnetic resonance imaging studies have highlighted alterations associated with BorPD phenotype. In particular, diffusion-weighted imaging/Diffusion tensor imaging (DWI/DTI) has identified many white matter structural alterations in individuals with this diagnosis. Although in its infancy, limiting this line of investigation is a lack of direction at the field level. Hence, the present paper aims to conduct a meta-analysis of DWI/DTI findings in individuals with a diagnosis of BorPD, testing the hypothesis that there are specific white matter alterations associated with BorPD. To this end, we performed a meta-analysis of the existing literature of DWI/DTI in BorPD representing a total of 123 individuals with BorPD and 117 Controls. Our results indicated that individuals with BorPD show regions of reduced fractional anisotropy in the corpus callosum and fornix. These results survived all jack-knife reshuffles and showed no publication bias. This suggests that alterations in these structures may contribute to psychopathology. Further, the present results lend support to extant psychological and biological models of BorPD.
... Narcissistic patients of this level define themselves as to be admired [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. [10,11]. ...
Starting from the general concept of "narcissism", the present work focuses on the essential aspects of personality disorder that define the clinical and diagnostic contexts, laying the foundations for correct differential diagnosis, without neglecting the neural characteristics developed by the scientific community. A new classification of the narcissistic disorder is presented that better defines the different types, in a more general framework of the "narcissistic spectrum". The discussion ends with the best suggested therapeutic approaches.
... neuroticism, extraversion, openness, agreeableness and conscientiousness) of the FFM can well capture key descriptors of different behavioral tendencies (Heine and Buchtel, 2009). Thus, elucidating et al., 2012;Bjornebekk et al., 2013;Coutinho et al., 2013;Kapogiannis et al., 2013;Koelsch et al., 2013;Liu et al., 2013;Taki et al., 2013;Forbes et al., 2014;Lu et al., 2014;Nostro et al., 2017;Schultz et al., 2017;Riccelli et al., 2017b;Ferschmann et al., 2018) and using diffusion MRI to evaluate white matter integrity (Xu and Potenza, 2012;Picerni et al., 2013;Nenadic et al., 2015;Lewis et al., 2016). There are also a large number of studies investigating the associations between brain function and personality by using functional MRI (fMRI) to measure task-induced brain activation (Canli and Amin, 2002;Eisenberger et al., 2005;Haas et al., 2006;Gioia et al., 2009;Cremers et al., 2010;Suslow et al., 2010;Kennis et al., 2013;Koelsch et al., 2013;Dima et al., 2015;Riccelli et al., 2017a), resting-state regional neural activity (Kunisato et al., 2011;Wei et al., 2011Wei et al., , 2014Gentili et al., 2017), functional connectivity (Adelstein et al., 2011;Ryan et al., 2011;Lei et al., 2013;Aghajani et al., 2014;Sampaio et al., 2014;Kruschwitz et al., 2015;Pang et al., 2016;Gentili et al., 2017;Tian et al., 2018) and functional network topology (Gao et al., 2013;Koelsch et al., 2013;Lei et al., 2015;Beaty et al., 2016). ...
Neuroimaging studies have linked inter-individual variability in the brain to individualized personality traits. However, only one or several aspects of personality have been effectively predicted based on brain imaging features. The objective of this study was to construct a reliable prediction model of personality in a large sample by using connectome-based predictive modeling (CPM), a recently developed machine learning approach. High-quality resting-state fMRI data of 810 healthy young participants from the Human Connectome Project dataset were used to construct large-scale brain networks. Personality traits of the five-factor model (FFM) were assessed by the NEO Five Factor Inventory. We found that CPM successfully and reliably predicted all the FFM personality factors (agreeableness, openness, conscientiousness and neuroticism) other than extraversion in novel individuals. At the neural level, we found that the personality-associated functional networks mainly included brain regions within default-mode, frontoparietal executive-control, visual, and cerebellar systems. Although different feature selection thresholds and parcellation strategies did not significantly influence the prediction results, some findings lost significance after controlling for confounds including age, gender, intelligence, and head motion. Our finding of robust personality prediction from an individual's unique functional connectome may help advance the translation of 'brain connectivity fingerprinting' into real-world personality psychological settings.
... • Recent brain imaging research (Nenadic et al., 2015;Schulze et al., 2013) comparing small samples of NPD individuals with controls describe grey matter deficits in the middle frontal gyri, middle prefrontal gyrus, and cingulate cortices as well as the anterior insular. Right prefrontal and bilateral medial prefrontal pathology may be linked to emotional regulation difficulties or cognitive deficits in attribution or coping while the anterior insular is linked to empathy. ...
Pathological narcissism has a long history dating back 2000 years, that has evolved into contemporary clinical psychology as a trait that may require clinical attention (Grenyer, 2013). Traditionally, Narcissistic personality disorder (NPD) is one of the 10 identified personality disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). An alternative trait-based model of personality disorders in DSM-5 described in Section III includes a more contemporary version of NPD. The former NPD description only describes the grandiose form characterized by a grandiose sense of self-importance, fantasies of success, power etc, a belief in one’s specialness, desire for admiration, sense of entitlement, interpersonal exploitativeness, and lack of empathy. The alternative NPD also describes impairments in functioning across identity, self-direction, empathy, and intimacy and while identifying pathological personality traits of grandiosity and attention seeking (both facets of antagonism) as well as more vulnerable narcissism presentations with aspects of negative affectivity such as depressivity and anxiousness (American Psychiatric Association, 2013). (see Pincus, Dowgwillo, & Greenberg (2016) for descriptions of 3 cases of NPD using the alternative DSM-5 model). Thus, contemporary views of pathological narcissism recognise both grandiose and vulnerable components.
... Recent studies focusing on neuropsychological aspects of emotion and interpersonal processing have identified several significant components and functions related to NPD and PN. One study using MRI scans to assess gray matter deficits in patients diagnosed with DSM-IV NPD suggests a neurological core for noticeable emotion dysregulation and fluctuations in internal control and control of emotions in NPD (Nenadic et al., 2015). Another study measured respiratory sinus arrhythmia and the cardiac pre-ejection period, and identified a psychophysiological base for emotional reactions in NPD (Sylvers, Brubaker, Alden, Brennan, & Lilienfeld, 2008). ...
Pathological narcissism (PN) and narcissistic personality disorder (NPD) have primarily been identified by striking external features, such as superiority, attention seeking and a critical or condescending attitude, and less attention has been paid to the internal processing contributing to this particular personality functioning. High dropout from treatment and challenges in building a therapeutic alliance with these patients call for further understanding of the complexity of disordered narcissism. Recent research on neuropsychological underpinnings to narcissistic pathology have provided valuable information that can inform therapeutic interventions for patients with this personality pathology. Internal processing in patients with PN or NPD is specifically influenced by compromised emotion processing and tolerance, identity diffusion, fluctuating sense of agency, reflective ability, perfectionism-related self- esteem, and ability to symbolize. The aim of this article is to review research studies with relevance for internal processing related to disordered narcissism and integrate findings with therapeutic strategies in alliance building with these patients.
... Likewise, the nonparametric Threshold-Free Cluster Enhancement (TFCE) correction with cluster-level P < 0.05 was adopted to alleviate the potential bias due to the multiple comparisons in the whole brain. This algorithm has been proven as a rigorous correction for the efficaciously limited false-positive rates in the nonstationary neuroimaging data (Smith and Nichols 2009;Nenadic et al. 2015). The threshold of statistical significance was set at P < 0.001 without correction to capture voxels or surfaces that were correlated with the procrastination, and then, we identified these surviving local dynamics of brain morphology after TFCE correction (TFCEC). ...
Globally, about 17% individuals are suffering from the maladaptive procrastination until now, which impacts individual's financial status, mental health, and even public policy. However, the comprehensive understanding of neuroanatomical understructure of procrastination still remains gap. 688 participants including 3 independent samples were recruited for this study. Brain morphological dynamics referred to the idiosyncrasies of both brain size and brain shape. Multilinear regression analysis was utilized to delineate brain morphological dynamics of procrastination in Sample 1. In the Sample 2, cross-validation was yielded. Finally, prediction models of machine learning were conducted in Sample 3. Procrastination had a significantly positive correlation with the gray matter volume (GMV) in the left insula, anterior cingulate gyrus (ACC), and parahippocampal gyrus (PHC) but was negatively correlated with GMV of dorsolateral prefrontal cortex (dlPFC) and gray matter density of ACC. Furthermore, procrastination was positively correlated to the cortical thickness and cortical complexity of bilateral orbital frontal cortex (OFC). In Sample 2, all the results were cross-validated highly. Predication analysis demonstrated that these brain morphological dynamic can predict procrastination with high accuracy. This study ascertained the brain morphological dynamics involving in self-control, emotion, and episodic prospection brain network for procrastination, which advanced promising aspects of the biomarkers for it.
... Functional alterations and structural alterations are, by nature, linked (Schulze et al., 2016). In addition to functional alternations and grey matter narcissistic (Nenadic et al., 2015) personality disorders-exhibit WM abnormalities. Given its potential efficaciousness on cognition and behaviour, it is important to analyse if WM abnormalities are also present in the individual with BorPD. ...
Borderline personality disorder (BorPD) is characterized by instability and impulsivity of mood, relationships and self-image. This disease is an important area of public health policy; compared to other psychiatric disorders, individuals with BorPD experience the most severe functional impairments. Nevertheless, for the patients that do recover, this recovery is stable and only few relapse back to psychopathology. Given its high rate of remission, the rewards of effective treatment options are clear. Identification of underlying anatomical and physiological changes is crucial to refine current treatments and develop new ones. In this perspective, previous magnetic resonance imaging studies have highlighted alterations associated with BorPD phenotype. In particular, diffusion weighted imaging (DWI) has identified many white matter structural alterations in individuals with this diagnosis. Although in its infancy, limiting this line of investigation is a lack of direction at the field level. Hence, the present paper aims to conduct a meta-analysis of DWI findings in individuals with a diagnosis of BorPD, testing the hypothesis that there are specific white matter alterations associated with BorPD. To this end, we performed a meta-analysis of the existing literature of DWI in BorPD representing a total of 123 individuals with BorPD and 117 Controls. Our results indicated that individuals with BorPD show regions of reduced fractional anisotropy in the corpus callosum and fornix. These results survived all jack-knife reshuffles and showed no publication bias. This suggest that alterations in these structures may contribute to psychopathology. Further, the present results lend support to extant psychological and biological models of BorPD.
... The work of Schulze et al. suggests specific structural changes in brain regions that are believed to correlate with deficits in a capacity to experience emotional empathy [36]. Nenadic et al. identified gray matter deficits consistent with the Schulze study, and also described right frontal lobe white matter alterations in their small sample [37]. While the research on the neurobiology of narcissistic personality is limited, it may provide useful psychoeducation for patients and families. ...
Purpose of Review
This paper aims to examine diagnostic sharing of narcissistic personality from multiple vantage points and to describe strategies that might help clinicians in patient management.
Recent Findings
In recent years, clinicians increasingly have been motivated to discuss with patients the diagnosis of borderline personality disorder (BPD), an intervention bolstered by the emergence of empirically validated treatments for BPD and by advocacy organizations calling for diagnostic sharing. Despite these advances, clinical experience suggests that the diagnosis of narcissistic personality, including narcissistic personality disorder (NPD) or clinically significant narcissistic traits, is rarely shared with patients. We review emerging information about diagnostic classification and assessment, epidemiology, heritability, neurobiology, prognosis, and the utility of evidence-based treatments, which may facilitate a conversation on diagnosis (as demonstrated in multiple clinical scenarios provided as examples).
Summary
Diagnostic sharing has become a central element in the informed consent process. Understanding the risks and benefits of sharing a diagnosis of narcissistic personality is essential for clinical practice.
... Replication in an independent sample was a particular strength in the present study. Attempting to replicate VBM results are complex because thousands of voxels are involved and previous studies have used the term 'replication' to indicate a qualitative similarity of cluster locations (Nenadic et al., 2015). In contrast in the meta-analysis we generated a single falsifiable hypothesis that a combined region of white matter was reduced in bipolar disorder and found strong support for this in the independent sample. ...
Converging evidence suggests that bipolar disorder (BD) is associated with white matter (WM) abnormalities. Meta-analyses of voxel based morphometry (VBM) data is commonly performed using published coordinates, however this method is limited since it ignores non-significant data. Obtaining statistical maps from studies (T-maps) as well as raw MRI datasets increases accuracy and allows for a comprehensive analysis of clinical variables. We obtained coordinate data (5-studies), T-Maps (12-studies, including unpublished data) and raw MRI datasets (5-studies) and analysed the 24 studies using Seed-based d Mapping (SDM). A VBM analysis was conducted to verify the results in an independent sample. The meta-analysis revealed decreased WM volume in the posterior corpus callosum extending to WM in the posterior cingulate cortex. This region was significantly reduced in volume in BD patients in the independent dataset (p=0.003) but there was no association with clinical variables. We identified a robust WM volume abnormality in BD patients that may represent a trait marker of the disease and used a novel methodology to validate the findings.
... One study by Sylvers and colleagues [43] found sympathetic activation and negative reactions to happy stimuli, and indifference to fearful and sad stimuli, which suggest a psychophysiological base for narcissistic emotion regulation. Other studies identified deficits in structural brain functioning in NPD, i.e., the prefrontal grey matter (GM) volume that affect emotion regulation and emotional empathic processing, which suggest a neurological core for noticeable fluctuations in NPD patients' self-regulation and control of emotions [44,45]. ...
Building an alliance with patients with pathological narcissism or narcissistic personality disorder, NPD, can be challenging and include avoidance, negative reactivity and disruptions. A main contributing factor can be the complex interaction between emotion and self-esteem regulation, which affects patients’ ability to engage in a therapeutic alliance and treatment. Recent studies, especially in neuroscience have identified functional characteristic and compromises in self-esteem and emotion regulation related to NPD. Self-enhancement, hyper reactivity and need for control, which patients within the range of disordered narcissism often present, can have different roots and underpinnings that require thorough exploration in the process of building the therapeutic alliance and promote change in treatment. Clinical examples with treatment implications and strategies will be discussed to highlight both internal fluctuations and external features and shifts in narcissistic personality functioning.
... Given the lack of research into NPD, we are at the beginning stages of development of a neurobiological model of the disorder. Nenadic et al. [68] provide the first account of potential prefrontal white matter alterations in people with NPD. These results are in concordance with Schulze et al. [69] who provided the first empirical evidence for structural abnormalities in fronto-paralimbic brain regions of patients with NPD. ...
Purpose of review:
This review summarizes recent executive functions research to better delineate the nosology of personality disorders.
Recent findings:
This review indicates that there are consistent impairments in executive functioning in people with personality disorders as compared with matched controls. Only five disorders were considered: borderline, obsessive-compulsive, antisocial, narcissistic, and schizotypal. Significant deficits are observed in decision-making, working memory, inhibition, and flexibility. Relevant data for the remaining personality disorders have not yet been published in relation to the executive functions.
Summary:
People with personality disorders could present a pattern of neurocognitive alterations that suggest a specific impairment of the prefrontal areas. The executive dysfunctions could partially explain the behavioral alterations in people with personality disorders.Further research should adopt broader considerations of effects of comorbidity and clinical heterogeneity, include community samples and, possibly, longitudinal designs with samples of youth.
... As this region is related to empathic functioning, the deficits in GM volume found in NPD patients affect their emotion regulation and emotional empathic processing. This can potentially also contribute to self-referential processing bias [37,38]. These studies suggest a neurological core for noticeable fluctuations in NPD patients' internal control and control of emotions, which are specifically related to instability in self-esteem and underlying vulnerability in NPD [4]. ...
This review is focused on integrating recent research on emotion regulation and empathic functioning with specific relevance for agency, control, and decision-making in narcissistic personality disorder (NPD, conceptualized as self direction in DSM 5 Section III). The neuroscientific studies of emotion regulation and empathic capability can provide some significant information regarding the neurological/neuropsychological underpinnings to narcissistic personality functioning. Deficiencies in emotion processing, compromised empathic functioning, and motivation can influence narcissistic self-regulation and agential direction and competence in social interactions and interpersonal intimate relationships. The aim is to expand our understanding of pathological narcissism and NPD and suggest relevant implications for building a collaborative treatment alliance.
Despite the clinical significance of narcissistic personality, its neural bases have not been clear yet, primarily due to methodological limitations of the previous studies, such as the low sample size, the use of univariate techniques and the focus on only one brain modality. In this study, we employed for the first time a combination of unsupervised and supervised machine learning methods, to identify the joint contributions of gray (GM) and white matter (WM) to narcissistic personality traits (NPT). After preprocessing, the brain scans of 135 participants were decomposed into eight independent networks of covarying GM and WM via Parallel ICA. Subsequently, stepwise regression and Random Forest were used to predict NPT. We hypothesize that a fronto-temporo parietal network mainly related to the Default Mode Network, may be involved in NPT and white matter regions related to these regions.
Results demonstrated a distributed network that included GM alterations in fronto-temporal regions, the insula, and the cingulate cortex, along with WM alterations in cerebellar and thalamic regions. To assess the specificity of our findings, we also examined whether the brain network predicting narcissism could predict other personality traits (i.e., Histrionic, Paranoid, and Avoidant personalities). Notably, this network did not predict these personality traits. Additionally, a supervised machine learning model (Random Forest) was used to extract a predictive model to generalize to new cases. Results confirmed that the same network could predict new cases. These findings hold promise for advancing our understanding of personality traits and potentially uncovering brain biomarkers associated with narcissism.
Introduction
Personality traits and the degree of their prominence determine various aspects of social interactions. Some of the most socially relevant traits constitute the Dark Triad – narcissism, psychopathy, and Machiavellianism – associated with antisocial behaviour, disregard for moral norms, and a tendency to manipulation. Sufficient data point at the existence of Dark Triad ‘profiles’ distinguished by trait prominence. Currently, neuroimaging studies have mainly concentrated on the neuroanatomy of individual dark traits, while the Dark Triad profile structure has been mostly overlooked.
Methods
We performed a clustering analysis of the Dirty Dozen Dark Triad questionnaire scores of 129 healthy subjects using the k-means method. The variance ratio criterion (VRC) was used to determine the optimal number of clusters for the current data. The two-sample t-test within the framework of voxel-based morphometry (VBM) was performed to test the hypothesised differences in grey matter volume (GMV) for the obtained groups.
Results
Clustering analysis revealed 2 groups of subjects, both with low-to-mid and mid-to-high levels of Dark Triad traits prominence. A further VBM analysis of these groups showed that a higher level of Dark Triad traits may manifest itself in decreased grey matter volumes in the areas related to emotional regulation (the dorsolateral prefrontal cortex, the cingulate cortex), as well as those included in the reward system (the ventral striatum, the orbitofrontal cortex).
Discussion
The obtained results shed light on the neurobiological basis underlying social interactions associated with the Dark Triad and its profiles.
Social dominance and subordination have been linked to fronto-limbic and fronto-thalamic networks and are related to phenotypes such as grandiose vs. vulnerable narcissistic traits. The latter have been linked to clinical features such as empathy and emotional regulation. In this study we tested the hypotheses that narcissistic traits are associated with white matter integrity in fasciculus uncinate, cingulum, and anterior thalamic radiation (ATR). We applied the Pathological Narcissism Inventory (PNI) to assess narcissistic traits in a sample of 267 psychiatrically healthy individuals. We used 3 T MRI to acquire Diffusion Tensor Imaging data for analysis with TBSS in FSL applying TFCE to test for correlations of fractional anisotropy (FA) and PNI scales. We detected a significant positive correlation of PNI total and FA in the right posterior cingulum. PNI Vulnerability was significantly correlated with FA in the left anterior and right posterior cingulum. We did not find overall correlations with PNI Grandiosity, but additional analyses showed significant effects with FA of ATR. Our results strengthen network models for narcissism underlying both personality variation and pathology. Especially associations of narcissistic vulnerability within fronto-limbic tracts suggest overlaps within neural correlates of related phenotypes like neuroticism, social subordination, and negative emotionality.
Narcissism is a multifaceted construct often linked to pathological conditions whose neural correlates of
narcissism are still poorly understood. Previous studies have reported inconsistent findings on the brain
regions probably due to methodological limitations, such as the low number of participants or the use of
mass univariate methods or instruments. The present study aims to overcome the previously methodological
limitations and build a predictive model of narcissism based on neural and psychological features underlying
individual differences in narcissistic personality traits. In this respect, two machine learning-based methods
were used to predict narcissistic traits from brain structural features and other normal and abnormal personality features. Results showed that a circuit including the lateral and middle frontal gyrus, the angular gyrus, Rolandic operculum and Heschl’s gyrus predicted the individual differences in narcissistic personality traits (p<0.003). Moreover, narcissistic traits were predicted by normal (openness, agreeableness,
conscientiousness) and abnormal (borderline, antisocial, insecure, addicted, negativistic, machiavellianism) personality traits. These results expand the possibility of predicting personality traits from neural and psychological features and can pave the way to build possible biomarkers of personality pathology. This study is the first
predictive based on a supervised machine learning approach that can be used to decode narcissistic personality traits.
Now in its fourth edition, the acclaimed Oxford Textbook of Psychopathology aims for both depth and breadth, with a focus on adult disorders and special attention given to personality disorders. It provides an unparalleled guide for professionals and students alike. Esteemed editors Robert F. Krueger and Paul H. Blaney selected the most eminent researchers in abnormal psychology to provide thorough coverage and to discuss notable issues in the various pathologies which are their expertise. This fourth edition of the Oxford Textbook of Psychopathology is fully updated and also reflects alternative, emerging perspectives in the field (e.g., the National Institute of Mental Health’s Research Domain Criteria Initiative [RDoC, the Hierarchical Taxonomy of Psychopathology [HiTOP]). The Textbook exposes readers to exceptional scholarship, the history and philosophy of psychopathology, the logic of the best approaches to current disorders, and an expert outlook on what researchers and mental health professionals will be facing in the years to come. This volume will be useful for all mental health workers, including clinical psychologists, psychiatrists, and social workers, and as a textbook focused on understanding psychopathology in depth for anyone wishing to be up to date on the latest developments in the field.
Neuroimaging studies have shown structural deficits in the default mode network (DMN) in patients with narcissistic personality disorder (NPD); however, the functional basis of the DMN in NPD remains unclear. This study aimed to explore the functional basis of the DMN in NPD from the perspective of the connectome. Nineteen young male patients with NPD (mean age, 18.47±0.77 years; range, 18–20 years) and 19 young male healthy control (HC) participants (mean age, 19.05±1.31 years; range, 18–22 years) were recruited for resting-state functional magnetic resonance imaging examinations. The DMN architecture was depicted by 20 DMN subregions. Graph theory approaches were applied to investigate the functional topology within the DMN in NPD, and Pearson correlations between network parameters and psychological scores were assessed. The NPD group demonstrated topological anomalies in the DMN indicated by a decrease in the clustering coefficient and local efficiency compared with the HC group. Additionally, the NPD group showed increased nodal clustering and efficiency in the right posterior cingulate cortex. In the NPD group, local efficiency within the DMN was found to be positively correlated with the Narcissistic Personality Inventory score and negatively correlated the Hiding the Self score. The NPD group showed abnormal topology within the DMN, indicating that the functional segregation of the DMN is disturbed in NPD. The destroyed topology of the DMN may represent a functional basis of the pathogenesis of NPD in young adult males and may be related to the increased vulnerability in NPD, including hiding the self.
This chapter reviews Narcissistic and Histrionic Personality Disorders (NPD, HPD) from three current perspectives. The categorical approach is exemplified in the DSM-5 Section II chapter on personality disorders. The categorical/dimensional hybrid approach is characterized by the DSM-5 Section III Alternative Model for Personality Disorders. Finally, both personality disorders are also conceptualized by purely dimensional and multidimensional models (e.g., pathological narcissism, histrionism). Integrative, interdisciplinary research and theory on NPD and pathological narcissism is expanding rapidly, providing novel clinical insights into classification, etiology, maintenance, patient presentation, and treatment. The clinical science of narcissism is robust, and its future appears quite promising. In contrast, contemporary research and theory on HPD and histrionism is scant and declining. Some have called for its elimination as a diagnostic entity. If the current trend of waning empirical and clinical interest persists, it is unlikely that HPD will be retained in future revisions of the DSM and other personality disorder classification systems.
Pathological narcissism and narcissistic personality disorder (NPD) are factors in numerous deviant behaviors, including white collar crime, domestic violence, physical aggression, and sexual violence. This chapter includes a discussion of clinical presentations of NPD and pathological narcissism, followed by ways in which clinical characteristics relate to the deviant behaviors found in empirical research. We then discuss forensic assessment of pathological narcissism traits, including considerations for the forensic interview and selection of appropriate assessment instruments. Two clinical cases in forensic settings are presented and assessed with scores from the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD). We conclude with explanations for the assessment findings, which are drawn from the clinical conceptualizations described in the chapter.
Narcissistic traits have been linked to structural and functional brain networks, including the insular cortex, however, with inconsistent findings. In this study, we tested the hypothesis that subclinical narcissism is associated with variations in regional brain volumes in insular and prefrontal areas. We studied 103 clinically healthy subjects, who were assessed for narcissistic traits using the Narcissistic Personality Inventory (NPI, 40-item version) and received high-resolution structural magnetic resonance imaging. Voxel-based morphometry was used to analyse MRI scans and multiple regression models were used for statistical analysis, with threshold-free cluster enhancement (TFCE). We found significant (p < 0.05, family-wise error FWE corrected) positive correlations of NPI scores with grey matter in multiple prefrontal cortical areas (including the medial and ventromedial, anterior/rostral dorsolateral prefrontal and orbitofrontal cortices, subgenual and mid-anterior cingulate cortices, insula, and bilateral caudate nuclei). We did not observe reliable links to particular facets of NPI-narcissism. Our findings provide novel evidence for an association of narcissistic traits with variations in prefrontal and insular brain structure, which also overlap with previous functional studies of narcissism-related phenotypes including self-enhancement and social dominance. However, further studies are needed to clarify differential associations to entitlement vs. vulnerable facets of narcissism.
It is important for counselors and educators to recognize, understand, and treat pathological narcissism in their students. Although mainstream studies about narcissism focus on clinical theories, recent empirical research provides new findings and perspectives. In this article, both types of studies are reviewed. While clinical studies, mainly based on psychodynamic theories, explain the organization of narcissistic personality, empirical research examines and simplifies those explanations and suggests alternative perspectives. Based on such review, the confliction and integration of a fragmented self-system and dyadic processes of social relation and emotion regulation are discussed.
We live in a world of limitless information. With technology advancing at an astonishingly fast pace, we are challenged to adapt to robotics and automated systems that threaten to replace us. Both at home and at work, an endless range of devices and Information Technology (IT) systems place demands upon our attention that human beings have never experienced before, but are our brains capable of processing it all? In this important new book, an in-depth view is taken of IT's under-studied dark side and its dire consequences on individuals, organizations, and society. With theoretical underpinnings from the fields of cognitive psychology, management, and information systems, the idea of brain overload is defined and explored, from its impact on our decision-making and memory to how we may cope with the resultant 'technostress'. Discussing the negative consequences of technology on work substitution, technologically induced work-family conflicts, and organizational design as well as the initiatives set up to combat these, the authors go on to propose measurement approaches for capturing the entangled aspects of IT-related overload. Concluding on an upbeat note, the book's final chapter explores emerging technologies that can illuminate our world when mindfully managed. Designed to better equip humans for dealing with new technologies, supported by case studies, and also exploring the idea of 'IT addiction', the book concludes by asking how IT processes may aid rather than hinder our cognitive functioning. This is essential reading for anyone interested in how we function in the digital age. © 2019 Anne-Françoise Rutkowski and Carol S. Saunders. All rights reserved.
The Criterion A of the DSM-5 Alternative Model of Personality Disorders follows a functional approach to personality disorders which can be effectively related to abnormalities in brain circuits that are involved in processes related to the self and others. While brain circuits related to the self and others highly overlap supporting the notion of inseparable constructs, structural and functional neuroimaging data point to rather specific deviations in brain processes among the various types of personality disorders, with a focus on borderline and antisocial personality disorders. Neurobiological data have shed light on the problem areas of individuals with personality disorders that goes beyond what we know from either patients' reports or observing their behavior and may open new perspectives on treatment.
Pathological narcissism is often characterized by arrogant behavior, a lack of empathy, and willingness to exploit other individuals. Generally, individuals with high levels of narcissism are more likely to suffer mental disorders. However, the brain structural basis of individual pathological narcissism trait among healthy people has not yet been investigated with surface-based morphometry. Thus, in this study, we investigated the relationship between cortical thickness (CT), cortical volume (CV), and individual pathological narcissism in a large healthy sample of 176 college students. Multiple regression was used to analyze the correlation between regional CT, CV, and the total Pathological Narcissism Inventory (PNI) score, adjusting for age, sex, and total intracranial volume. The results showed that the PNI score was significantly negatively associated with CT and CV in the right dorsolateral prefrontal cortex (DLPFC, key region of the central executive network, CEN), which might be associated with impaired emotion regulation processes. Furthermore, the PNI score showed significant negative associations with CV in the right postcentral gyrus, left medial prefrontal cortex (MPFC), and the CT in the right inferior frontal cortex (IFG, overlap with social brain network), which may be related to impairments in social cognition. Together, these findings suggest a unique structural basis for individual differences in pathological narcissism, distributed across different gray matter regions of the social brain network and CEN.
Migraine with aura (MA) is characterized by cortical dysfunction. Frequent aura attacks may alter cerebral cortical structure in patients, or structural grey matter abnormalities may predispose MA patients to aura attacks. In the present study we aimed to investigate cerebral grey matter structure in a large group of MA patients with and without sensory aura (i.e. gradually developing, transient unilateral sensory disturbances). We included 60 patients suffering from migraine with typical visual aura and 60 individually age and sex-matched controls. Twenty-nine of the patients additionally experienced sensory aura regularly. We analysed high-resolution structural MR images using two complimentary approaches and compared patients with and without sensory aura. Patients were also compared to controls. We found no differences of grey matter density or cortical thickness between patients with and without sensory aura and no differences for the cortical visual areas between patients and controls. The somatosensory cortex was thinner in patients (1.92mm vs. 1.96mm, P=0.043) and the anterior cingulate cortex of patients had a decreased grey matter density (P=0.039) compared to controls. These differences were not correlated to the clinical characteristics. Our results suggest that sensory migraine aura is not associated with altered grey matter structure and that patients with visual aura have normal cortical structure of areas involved in visual processing. The observed decreased grey matter volume of the cingulate gyrus in patients compared to controls have previously been reported in migraine with and without aura, but also in a wide range of other neurologic and psychiatric disorders. Most likely, this finding generally reflects bias between patients and healthy controls.
Whether emotion is a source of moral judgments remains controversial. This study combined neurophysiological measures, including functional magnetic resonance imaging, eye-tracking, and pupillary response with behavioral measures assessing affective and moral judgments across age. One hundred and twenty-six participants aged between 4 and 37 years viewed scenarios depicting intentional versus accidental actions that caused harm/damage to people and objects. Morally, salient scenarios evoked stronger empathic sadness in young participants and were associated with enhanced activity in the amygdala, insula, and temporal poles. While intentional harm was evaluated as equally wrong across all participants, ratings of deserved punishments and malevolent intent gradually became more differentiated with age. Furthermore, age-related increase in activity was detected in the ventromedial prefrontal cortex in response to intentional harm to people, as well as increased functional connectivity between this region and the amygdala. Our study provides evidence that moral reasoning involves a complex integration between affective and cognitive processes that gradually changes with age and can be viewed in dynamic transaction across the course of ontogenesis. The findings support the view that negative emotion alerts the individual to the moral salience of a situation by bringing discomfort and thus can serve as an antecedent to moral judgment.
The concept of narcissism has been much researched in psychoanalysis and especially in self psychology. One of the hallmarks of narcissism is altered emotion, including decreased affective resonance (e.g. empathy) with others, the neural underpinnings of which remain unclear. The aim of our exploratory study was to investigate the psychological and neural correlates of empathy in two groups of healthy subjects with high and low narcissistic personality trait. We hypothesized that high narcissistic subjects would show a differential activity pattern in regions such as the anterior insula that are typically associated with empathy.
A sample of 34 non-clinical subjects was divided into high (n=11) and low (n=11) narcissistic groups according to the 66th and 33rd percentiles of their scores on the Narcissism Inventory (NI). Combining the psychological, behavioral and neuronal [i.e. functional magnetic resonance imaging (fMRI)] measurements of empathy, we compared the high and low narcissistic groups of subjects.
High narcissistic subjects showed higher scores on the Symptom Checklist-90 - Revised (SCL-90-R) and the 20-item Toronto Alexithymia Scale (TAS-20) when compared to low narcissistic subjects. High narcissistic subjects also showed significantly decreased deactivation during empathy, especially in the right anterior insula.
Psychological and neuroimaging data indicate respectively higher degrees of alexithymia and lower deactivation during empathy in the insula in high narcissistic subjects. Taken together, our preliminary findings demonstrate, for the first time, psychological and neuronal correlates of narcissism in non-clinical subjects. This might stipulate both novel psychodynamic conceptualization and future psychological-neuronal investigation of narcissism.
The diagnosis of narcissistic personality disorder in the DSM-IV has been criticized foremost for its limitations in capturing the range and complexity of narcissistic pathology. The attention to the narcissistic individual's external, symptomatic, or social interpersonal patterns--at the expense of his or her internal complexity and individual suffering--has also added to the diagnosis' low clinical utility and limited guidance for treatment. Recent studies and reviews have pointed to the need for change in the diagnostic approach to and formulation of narcissism. This review focuses specifically on studies of features that add to the identification, understanding, and treatment of patients with pathological narcissistic functioning and narcissistic personality disorder. They have been integrated into a regulatory model that includes the functions and fluctuations of internal control, self-esteem, perfectionism with accompanying self-criticism, shame, and empathic ability and functioning.
Empathy is a concept central to psychiatry, psychotherapy and clinical psychology. The construct of empathy involves not only the affective experience of the other person's actual or inferred emotional state but also some minimal recognition and understanding of another's emotional state. It is proposed, in the light of multiple levels of analysis including social psychology, cognitive neuroscience and clinical neuropsychology, a model of empathy that involves both bottom-up and top-down information processing underpinned by parallel and distributed computational mechanisms. The predictive validity of this model is explored with reference to clinical conditions. As many psychiatric conditions are associated with deficits or even lack of empathy, we discuss a limited number of these disorders including psychopathy/antisocial personality disorders, borderline and narcissistic personality disorders, autistic spectrum disorders, and alexithymia. We argue that future clinical investigations of empathy disorders can only be informative if behavioral, dispositional and biological factors are combined.
Spatial normalization of diffusion tensor images plays a key role in voxel-based analysis of white matter (WM) group differences. Currently, it has been achieved using low-dimensional registration methods in the large majority of clinical studies. This paper aims to motivate the use of high-dimensional normalization approaches by generating evidence of their impact on the findings of such studies. Using an ongoing amyotrophic lateral sclerosis (ALS) study, we evaluated three normalization methods representing the current range of available approaches: low-dimensional normalization using the fractional anisotropy (FA), high-dimensional normalization using the FA, and high-dimensional normalization using full tensor information. Each method was assessed in terms of its ability to detect significant differences between ALS patients and controls. Our findings suggest that inadequate normalization with low-dimensional approaches can result in insufficient removal of shape differences which in turn can confound FA differences in a complex manner, and that utilizing high-dimensional normalization can both significantly minimize the confounding effect of shape differences to FA differences and provide a more complete description of WM differences in terms of both size and tissue architecture differences. We also found that high-dimensional approaches, by leveraging full tensor features instead of tensor-derived indices, can further improve the alignment of WM tracts.
Self-injurious behavior in borderline personality disorder is a frequent cause of morbidity and mortality, but neurobiological studies examining this behavior are few. Nine women with borderline personality disorder self-injurious behavior and seven comparison subjects underwent diffusion tensor imaging (DTI). Trace and fractional anisotropy (FA) were calculated for frontal and posterior regions. Borderline personality disorder-self-injurious behavior subjects also underwent a battery of neuropsychological tests that emphasized executive functions. They had significantly higher trace and lower FA in inferior frontal but not posterior regions. Correlational analyses between DTI and cognitive variables showed a pattern of results that was contrary to expectations with posterior white matter integrity correlating with isolated measures of executive function and anterior white matter integrity correlating with a component of verbal memory test performance. Women with borderline personality disorder-self-injurious behavior exhibit decreased white matter microstructural integrity in inferior frontal brain regions that may include components of orbito-frontal circuitry.
In recent years, diffusion-weighted magnetic resonance imaging has attracted considerable attention due to its unique potential to delineate the white matter pathways of the brain. However, methodologies currently available and in common use among neuroscientists and clinicians are typically based on the diffusion tensor model, which has comprehensively been shown to be inadequate to characterize diffusion in brain white matter. This is due to the fact that it is only capable of resolving a single fiber orientation per voxel, causing incorrect fiber orientations, and hence pathways, to be estimated through these voxels. Given that the proportion of affected voxels has been recently estimated at 90%, this is a serious limitation. Furthermore, most implementations use simple “deterministic” streamlines tracking algorithms, which have now been superseded by “probabilistic” approaches. In this study, we present a robust set of tools to perform tractography, using fiber orientations estimated using the validated constrained spherical deconvolution method, coupled with a probabilistic streamlines tracking algorithm. This methodology is shown to provide superior delineations of a number of known white matter tracts, in a manner robust to crossing fiber effects. These tools have been compiled into a software package, called MRtrix, which has been made freely available for use by the scientific community. © 2012 Wiley Periodicals, Inc. Int J Imaging Syst Technol, 22, 53–66, 2012
Background:
Despite the relevance of narcissistic personality disorder (NPD) in clinical settings, there is currently no empirical data available regarding the neurobiological correlates of NPD. In the present study, we performed a voxel-based morphometric analysis to provide initial insight into local abnormalities of gray matter (GM) volume.
Methods:
Structural brain images were obtained from patients with NPD (n = 17) and a sample of healthy controls (n = 17) matched regarding age, gender, handedness, and intelligence. Groups were compared with regard to global brain tissue volumes and local abnormalities of GM volume. Regions-of-interest analyses were calculated for the anterior insula.
Results:
Relative to the control group, NPD patients had smaller GM volume in the left anterior insula. Independent of group, GM volume in the left anterior insula was positively related to self-reported emotional empathy. Complementary whole-brain analyses yielded smaller GM volume in fronto-paralimbic brain regions comprising the rostral and median cingulate cortex as well as dorsolateral and medial parts of the prefrontal cortex.
Conclusion:
Here we provide the first empirical evidence for structural abnormalities in fronto-paralimbic brain regions of patients with NPD. The results are discussed in the context of NPD patients' restricted ability for emotional empathy.
Purpose of review:
This article will discuss the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5 proposal for narcissistic personality disorder (NPD), and highlight some of the advantages of introducing a dual diagnostic approach that includes a dimensional conceptualization for identifying and diagnosing pathological narcissism and NPD, in addition to specific traits.
Recent findings:
Reviews and studies have specifically highlighted how people with NPD behave and are observed by others, and the negative consequences of their behavior. Accounts on the subjective perspectives of pathological narcissism stem foremost from psychoanalytic and psychodynamic accounts, but they have remained relatively separated from diagnostic and empirical studies.
Summary:
The new diagnostic approach to NPD can encourage a better integration of the clinicians' observations of indicators of pathological narcissism from an external perspective and the patients' formulations of their own subjective experiences and understanding of their problems.
Prefrontal cortex plays a major role in the modulation of behaviors and emotions through regulation of both information processing and impulse control. Low prefrontal function in borderline personality disorder (BPD) has been consistently reported by a number of studies using neuropsychological assessments and functional neuroimaging techniques. To further explore this findings, this study aimed to investigate microstructural damage of prefrontal white matter tracts in subjects with BPD by using the novel, voxel-based approach, tract-based spatial statistics (TBSS).
A Diffusion Tensor Image (DTI) study was performed in 28 patients with DSM-IV BPD (13 males and 15 females) and in 26 healthy control subjects. Voxel wise analysis was performed using TBSS (diffusion toolbox of FSL - functional MRI Software Library) to localize regions of white matter showing significant changes of fractional anisotropy (FA).
TBSS analysis revealed a statistically significant decrease of FA in the genu and rostral areas of the corpus callosum (p<0.005), as well as in left and right prefrontal white matter fasciculi (p<0.002) in BPD participants compared with controls. White matter abnormalities were not correlated with age, neurological symptoms or comorbid ADHD.
Despite the reduced sample size, the results are in line with previous findings on reduced orbitofrontal functions in BPD with prominent affective-depressive feature and suggest that emotional and behavioral symptoms of BPD patients might be associated to damage at the connectivity tracts in these brain areas.
There has been much recent interest in using magnetic resonance diffusion imaging to provide information about anatomical connectivity in the brain, by measuring the anisotropic diffusion of water in white matter tracts. One of the measures most commonly derived from diffusion data is fractional anisotropy (FA), which quantifies how strongly directional the local tract structure is. Many imaging studies are starting to use FA images in voxelwise statistical analyses, in order to localise brain changes related to development, degeneration and disease. However, optimal analysis is compromised by the use of standard registration algorithms; there has not to date been a satisfactory solution to the question of how to align FA images from multiple subjects in a way that allows for valid conclusions to be drawn from the subsequent voxelwise analysis. Furthermore, the arbitrariness of the choice of spatial smoothing extent has not yet been resolved. In this paper, we present a new method that aims to solve these issues via (a) carefully tuned non-linear registration, followed by (b) projection onto an alignment-invariant tract representation (the "mean FA skeleton"). We refer to this new approach as Tract-Based Spatial Statistics (TBSS). TBSS aims to improve the sensitivity, objectivity and interpretability of analysis of multi-subject diffusion imaging studies. We describe TBSS in detail and present example TBSS results from several diffusion imaging studies.
Many image enhancement and thresholding techniques make use of spatial neighbourhood information to boost belief in extended areas of signal. The most common such approach in neuroimaging is cluster-based thresholding, which is often more sensitive than voxel-wise thresholding. However, a limitation is the need to define the initial cluster-forming threshold. This threshold is arbitrary, and yet its exact choice can have a large impact on the results, particularly at the lower (e.g., t, z < 4) cluster-forming thresholds frequently used. Furthermore, the amount of spatial pre-smoothing is also arbitrary (given that the expected signal extent is very rarely known in advance of the analysis). In the light of such problems, we propose a new method which attempts to keep the sensitivity benefits of cluster-based thresholding (and indeed the general concept of "clusters" of signal), while avoiding (or at least minimising) these problems. The method takes a raw statistic image and produces an output image in which the voxel-wise values represent the amount of cluster-like local spatial support. The method is thus referred to as "threshold-free cluster enhancement" (TFCE). We present the TFCE approach and discuss in detail ROC-based optimisation and comparisons with cluster-based and voxel-based thresholding. We find that TFCE gives generally better sensitivity than other methods over a wide range of test signal shapes and SNR values. We also show an example on a real imaging dataset, suggesting that TFCE does indeed provide not just improved sensitivity, but richer and more interpretable output than cluster-based thresholding.
The empathic brain and its dysfunction in psychiatric populations: implications for intervention across different clinical conditions A neurobehavioral evolutionary perspective on the mechanisms underlying empathy
- J Decety
- Y Moriguchi
- J Decety
- G J Norman
- G G Berntson
- J T Cacioppo
Decety, J., Moriguchi, Y., 2007. The empathic brain and its dysfunction in psychiatric populations: implications for intervention across different clinical conditions. BioPsychoSocial Medicine 1, 22. Decety, J., Norman, G.J., Berntson, G.G., Cacioppo, J.T., 2012b. A neurobehavioral evolutionary perspective on the mechanisms underlying empathy. Progress in Neurobiology 98, 38-48.