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Few studies have examined associations between pathological narcissism and self-harm, but those that do indicate that narcissistic vulnerability (not narcissistic grandiosity) relates to self-harm. The current study extends this literature by investigating how facets of pathological narcissism assessed by the Pathological Narcissism Inventory (Pincus et al., 2009) relate to specific non-suicidal self-injury (NSSI) behaviors assessed by the Inventory of Statements About Self-Injury (Klonsky & Glenn, 2009) using statistical models appropriate for non-normally distributed count data. In a sample of 1,023 undergraduate students, results revealed that facets of both narcissistic vulnerability and narcissistic grandiosity were differentially related to the endorsement and frequency of specific NSSI behaviors and higher-order latent NSSI factors (repetitive and impulsive), even after accounting for levels of borderline pathology. The clinical implications of these results are discussed.
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Journal of Personality Disorders, 32(1), 87-108, 2018
© 2018 The Guilford Press
From The Pennsylvania State University, University Park, Pennsylvania (S. D., A. L. P.); Michigan State
University, East Lansing, Michigan (H. S. S.); and Texas A & M University, College Station, Texas (M.
B. D.).
Address correspondence to Sindes Dawood, The Pennsylvania State University, 361 Moore Building,
University Park, PA 16802. E-mail:
Sindes Dawood, MS, Hans S. Schroder, MA,
M. Brent Donnellan, PhD, and Aaron L. Pincus, PhD
Few studies have examined associations between pathological narcissism
and self-harm, but those that do indicate that narcissistic vulnerability (not
narcissistic grandiosity) relates to self-harm. The current study extends this
literature by investigating how facets of pathological narcissism assessed
by the Pathological Narcissism Inventory relate to specific nonsuicidal
self-injury (NSSI) behaviors assessed by the Inventory of Statements About
Self-Injury using statistical models appropriate for non-normally distributed
count data. In a sample of 1,023 undergraduate students, results revealed
that facets of both narcissistic vulnerability and narcissistic grandiosity were
differentially related to the endorsement and frequency of specific NSSI be-
haviors and higher-order latent NSSI factors (repetitive and impulsive), even
after accounting for levels of borderline pathology. The clinical implications
of these results are discussed.
Pathological narcissism is related to both suicide and nonsuicidal self-injury
(e.g., Ansell et al., 2015; Pincus et al., 2009). Suicide refers to the deliber-
ate act of injuring oneself with the intent to die (Posner, Oquendo, Gould,
Stanley, & Davies, 2007), whereas nonsuicidal self-injury (NSSI) refers to
the intentional damage of one’s body without suicidal intent (Muehlenkamp,
2005). NSSI includes behaviors such as hair pulling, self-hitting, cutting,
carving words or pictures into skin, and burning (Klonsky, 2007). Most of
the existing research focuses on relations between global assessments of nar-
cissism such as the diagnosis of narcissistic personality disorder (NPD) and
suicide attempts or presence/absence of NSSI. The current study extends this
research by examining how facets of pathological narcissism relate to specific
NSSI behaviors using statistical models appropriate for count data with non-
normal distributions.
NPD and pathological narcissism (i.e., narcissistic grandiosity and nar-
cissistic vulnerability) are both significant risk factors for suicidal behavior
in adolescents, adults, and the elderly. For instance, early research found be-
tween 4.7% and 23% of suicide completers exhibited elevated symptoms of
NPD (Apter et al., 1993; Brent et al., 1994). More recent work confirms that
NPD is a risk factor for suicide attempts (García-Nieto, Blasco-Fontecilla, de
León-Martinez, & Baca-García, 2014; Giner et al., 2013; Soloff & Chiap-
petta, 2012) and a unique predictor (among personality disorder diagnoses)
of making multiple suicide attempts over a 10-year period (Ansell et al.,
2015). Further, the presence of comorbid depression is associated with an in-
creased risk of suicide for individuals with NPD (Conner et al., 2001; Heisel,
Links, Conn, van Reekum, & Flett, 2007). However, it is important to note
that narcissistic individuals are at heightened risk for suicide even when not
clinically depressed (Cross, Westen, & Bradley, 2011; Links, 2013; Ronning-
stam & Maltsberger, 1998; Ronningstam, Weinberg, & Malstberger, 2008).
Moreover, NPD is associated with suicide attempts characterized by lower
impulsivity but higher expected lethality (Blasco-Fontecilla et al., 2009), and
these attempts tend to be associated with certain life stressors/changes (e.g.,
being fired from a job, having more arguments with a spouse; Blasco-Fonte-
cilla et al., 2010).
Both narcissistic grandiosity (maladaptive self-enhancement motivation
characterized by an inflated self view with concomitant aggrandizing fanta-
sies, a sense of entitlement, and interpersonal exploitativeness) and narcissis-
tic vulnerability (impaired self, emotion, and behavior regulation in response
to self-enhancement failures and lack of recognition and admiration from
others) are related to suicide attempts, but only narcissistic vulnerability ap-
pears associated with NSSI (Miller et al., 2010; Pincus et al., 2009; Thomas
et al., 2012). Consistent with this, symptoms of NPD, which consist pri-
marily of narcissistic grandiosity, are not reliably associated with NSSI in
adolescent and college student samples (Casillas & Clark, 2002; Tromp &
Koot, 2010). However, military recruits with a history of NSSI scored higher
on NPD (and other Diagnostic and Statistical Manual of Mental Disorders,
fourth edition [DSM-IV] personality disorders) than recruits without a his-
tory of NSSI (Klonsky, Oltmanns, & Turkheimer, 2003). In summary, unique
associations between NSSI and narcissistic vulnerability seem well support-
ed, but the evidence linking NSSI and narcissistic grandiosity appears mixed.
The present study aimed to clarify the relationship between pathological
narcissism and NSSI. Prior research pertaining to narcissism and suicidality
has focused almost entirely on associations between narcissism and suicide
or narcissism and the presence/absence of self-harm. There is a need to un-
derstand exactly which features of suicidality and/or NSSI behavior are re-
lated to narcissism, as both are important clinical constructs to examine in
relation to various forms of personality pathology. Recent research shows
that individual differences such as sensation seeking and trait aggression are
related to specific forms of NSSI (Kleiman et al., 2015; Knorr, Jenkins, &
Conner, 2013). Given that borderline personality disorder (BPD) has also
long been associated with NSSI (e.g., Brown, Comtois, & Linehan, 2002;
Kleindienst et al., 2008; Lieb, Zanarini, Schmahl, Linehan, & Bohus, 2004),
and self-harm is a diagnostic criterion for BPD (American Psychiatric As-
sociation, 2013), this study investigated whether and how distinct facets of
pathological narcissism relate to specific NSSI behaviors after accounting for
levels of BPD. We expected that facets of both narcissistic vulnerability and
grandiosity would be associated with various NSSI behaviors even control-
ling for symptoms of BPD.
The current sample is drawn from undergraduate students. Accordingly,
we evaluated the prevalence of NSSI in the sample to make sure there were
adequate instances to investigate our research questions. We also consider
how participants with reports of NSSI compare to those who did not endorse
NSSI. Klonsky (2011) used a random-digit dialing procedure to investigate
NSSI in adults from the United States and found that age was among the
strongest demographic predictors of NSSI. Participants under 30 years of age
were more likely to report NSSI than participants over 30 years. Income and
educational history were not statistically significant correlates of reports of
NSSI in that sample. This suggests that samples of younger participants are
particularly well suited for studying correlates of NSSI given considerations
of statistical power. Standard concerns about the selective nature of college
samples in terms of education background and socioeconomic status might
not be as significant, given that these factors are not strongly associated with
NSSI (e.g., Klonsky, 2011). Moreover, Whitlock, Eckenrode, & Silverman
(2006) found that many NSSI behaviors were undisclosed to clinical profes-
sionals, suggesting the importance of using nonselective samples to study this
clinically relevant phenomenon.
Participants were undergraduate students from a large Midwestern universi-
ty who completed study questionnaires for partial course credit. Data collec-
tion was ongoing throughout the semester, and a total of 1,389 participants
initiated the survey. We included four items to detect inattentive responding
(e.g., “Please choose answer choice 2 to ensure you are paying attention”),
and excluded participants who failed to respond to all four items accurately
(Maniaci & Rogge, 2014; n = 363). An additional three participants were
excluded from study analyses because of outlier NSSI behavior data. Specifi-
cally, count data for rubbing skin against rough surface, wound picking, and
biting were equal to or greater than 1,000,000 for these participants. Thus,
the final sample consisted of 1,023 undergraduates (712 female, 268 male,
4 declined to respond, and 39 missed responses; Mage = 19.84, SD = 1.78).
The racial/ethnic makeup of the sample was 75.30% European American,
9.00% African American, 8.90% Asian, 5.00% Latino/Hispanic, 2.7% Bi-
racial, .90% American Indian, and 1.70% Other (participants could pick
more than one category). All participants consented to the study prior to
data collection, and the university’s institutional review board approved all
Pathological Narcissism. The Pathological Narcissism Inventory (PNI; Pin-
cus, 2013; Pincus et al., 2009) is a 52-item self-report measure of pathologi-
cal narcissism. The PNI has seven subscales that capture facets of narcissistic
grandiosity (i.e., exploitativeness, self-sacrificing self-enhancement, grandi-
ose fantasy) and narcissistic vulnerability (i.e., contingent self-esteem, hiding
the self, devaluing, and entitlement rage). All items are scored on a 6-point
scale ranging from 0 (“Not At All”) to 5 (“Very Much Like Me”). A large
body of laboratory (e.g., Fetterman & Robinson, 2010), clinical (e.g., El-
lison, Levy, Cain, Ansell, & Pincus, 2013; Morf et al., 2016), longitudinal
(e.g., Roche, Pincus, Conroy, Hyde, & Ram, 2013), and correlational (e.g.,
Roche, Pincus, Hyde, Conroy, & Ram, 2013; Wright et al., 2013) research
supports the validity of the PNI. In this sample, Cronbach’s alphas ranged
from .72 to .93 for the scales.
Nonsuicidal Self-Injury. The Inventory of Statements About Self-Injury
(ISAS; Klonsky & Glenn, 2009) is a self-report measure that assesses the fre-
quency and functions of nonsuicidal self-injury (NSSI). The ISAS is broken
up into two sections. The first section assesses the lifetime frequency of 12
different NSSI behaviors that are enacted on purpose but without suicidal
intent (biting, burning, carving, cutting, hitting/banging body parts, interfer-
ing with wound healing [wound picking], sticking self with needles, pinch-
ing, hair pulling, rubbing skin against rough surfaces, severe scratching, and
swallowing dangerous substances). The second section of the ISAS assesses
13 specific functions that are commonly related to NSSI (e.g., Affect Regula-
tion, Self-Punishment, Sensation Seeking). Studies have found the ISAS to
be a reliable and valid measure of NSSI frequency and functions in a large
sample of young adults (Glenn & Klonsky, 2011; Klonsky & Glenn, 2009;
Klonsky & Olino, 2008). For the purposes of this study, we focused analyses
on the lifetime frequency of specific NSSI behaviors and did not consider
functions of NSSI. In general, more research with the ISAS focuses on the
frequency scales than the functions scales (e.g., Brausch & Boone, 2015;
Hamza & Willoughby, 2013; Klonsky, May, & Glenn, 2013; Nicolai, Wiel-
gus, & Mezulis, 2016).
Some researchers also suggest that classifying NSSI behaviors into dis-
tinct types may be helpful in their conceptualization, assessment, and treat-
ment (Favazza, 2012; Favazza & Rosenthal, 1990; Favazza & Simeon, 1995;
Simeon & Hollander, 2008). Their classification system divides NSSI behav-
iors into four major categories: stereotypic NSSI (i.e., highly repetitive, fixed,
driven acts without thought that cause tissue damage ranging from mild to
severe to even life threatening, such as hair pulling, hitting/banging the self,
skin picking, or scratching); major NSSI (i.e., highly impulsive or planned
acts that are most severe or life threatening, such as castration, limb amputa-
tion); compulsive NSSI (i.e., repetitive, often ritualistic acts that tend to be
mild to moderate, such as hair pulling, skin picking, nail biting); and impul-
sive NSSI (i.e., behaviors that are not highly repetitive but often episodic and
gratifying, such as skin cutting, skin burning, self-hitting). However, given
that there is overlap between the categories, other researchers (Favaro &
Santonastaso, 1998, 2000; Mathews et al., 2004) have proposed and em-
pirically validated simpler two-factor classification systems that resemble the
system proposed by Favazza and colleagues (Favazza & Rosenthal, 1990;
Favazza & Simeon, 1995). That is, one category (regarded as “compulsive”
or “moderate” NSSI) consists of symptoms from both the compulsive and
stereotypic categories, while the second category (regarded as “impulsive”
or “severe”) consists of symptoms from the impulsive and major catego-
ries. Research finds that episodic forms of NSSI (e.g., cutting, burning) are
more strongly related to specific precipitating events than are mildly habitual
forms of NSSI (e.g., skin picking, nail biting; Croyle & Waltz, 2007). Based
on theory and previous research, we evaluated the latent structure of NSSI
behaviors in the current sample, discussed below, to identify the best fitting
model to be used to examine associations between facets of pathological
narcissism and higher-order latent factors of NSSI.
Borderline Pathology. The Borderline Personality Questionnaire (BPQ; Poreh
et al., 2006) is an 80-item true-false questionnaire measuring thoughts, feel-
ings, and behaviors associated with BPD. The BPQ was scored without the
suicide/self-mutilation subscale to avoid criterion contamination with the
study’s primary outcome (self-injury). A total score was used, with higher
values reflecting higher levels of borderline pathology. Cronbach’s alpha was
.94 for the BPQ.
To further characterize the sample’s psychological symptom and behav-
ior endorsement, we administered a number of other validated self-report
measures, described below.
Antisocial Behavior. Antisocial behavior was measured with the Subtypes
of Antisocial Behavior Questionnaire (STAB; Burt & Donnellan, 2009).
The STAB consists of a 32 items assessing physical aggression (“Felt like
hitting someone”), rule-breaking (“Stole property from work or school”),
and social aggression (“Called someone names behind his/her back”). Each
subscale asks participants to rate the items on a 5-point scale ranging from
“never” to “nearly all the time.” For the current study, the total score was
used and Cronbach’s alpha was .92.
Depression Symptoms. The Patient Health Questionnaire–9 (PHQ-9; Kroen-
ke et al., 2001) is a 10-item measure of depression. On the PHQ-9, partici-
pants indicate the extent to which they experienced each of nine depressive
symptoms (e.g., “Feeling down, depressed, or hopeless”) over the past two
weeks on a 0 (Not at all) to 3 (Nearly every day) rating scale. Items were
summed for analysis, and Cronbach’s alpha was .90.
Posttraumatic Stress Disorder Symptoms. The Posttraumatic Checklist for
DSM-5 (PCL-5; Blevins et al., 2015; Weathers et al., 2013) is a 20-item self-
report measure of Diagnostic and Statistical Manual of Mental Disorders,
fifth edition (DSM-5) symptoms of posttraumatic stress disorder (PTSD) ex-
perienced during the past month. Items (e.g., “In the past month, how much
were you bothered by: repeated, disturbing, and unwanted memories of the
stressful experience?”) are rated on a scale of 0 (Not at all) to 4 (Extremely).
Items on the PCL-5 were summed for analysis, and Cronbach’s alpha was
Drug Use. The Drug Abuse Screening Test-10 (DAST-10; Skinner, 1982) is
a 10-item (Yes/No) self-report measure used to screen for drug abuse prob-
lems in treatment-seeking individuals (Cocco & Carey, 1998; Skinner, 1982),
including college students with substance use problems (Taylor, James, Bo-
badilla, & Reeves, 2008). Items were averaged to score the DAST, and Cron-
bach’s alpha was .71.
Alcohol Abuse. Alcohol abuse was measured with items from the Patient-
Reported Outcomes Measurement Information System–Alcohol Use Short
Form (PROMIS-Alc; Pilkonis et al., 2013). Participants responded to seven
items using a 5-point scale ranging from “Never” to “Almost Always” re-
garding alcohol abuse (e.g., “I spent too much time drinking”) in the past
30 days. Because the PROMIS-Alc items target respondents who have had
a drink in the previous 30 days, data were available from 794 respondents.
Items on the PROMIS-Alc were summed for analysis, and Cronbach’s alpha
was .91.
Psychological Treatment History. Finally, we assessed whether participants
had ever had experience with professional treatment for a mental health
or emotional problem; we specifically asked about psychological therapy,
psychiatric medication, and psychiatric hospitalization. For the therapy and
medication questions, participants chose one of the following options: “No,
never,” “No, but I would like to,” Yes, in the past,” or “Yes, currently.”
Items were then coded such that “No, never” and “No, but I would like to”
were scored as 0 and the other two options were scored as 1. For the hospi-
talization item, participants were asked if they had ever been hospitalized for
an emotional problem.
Prior to all analyses, we evaluated the normality of the data using SPSS ver-
sion 22 (SPSS Inc., Chicago, IL), and found that all NSSI behavior count data
violated normality assumptions, as they exhibited significant positive skew-
ness (M = 18.386; range = 10.937–31.096) and high kurtosis (M = 410.165;
range = 152.315–982.263), and all distributions were zero inflated. Figure 1
provides an example of such a distribution using the ISAS pinching behavior
We also used the PSCL package in R (Zeileis, Kleiber, & Jackman, 2008)
to determine the statistical model most appropriate for non-normally distrib-
uted count data, as well as for all regression analyses estimating associations
between narcissism/BPD and different latent NSSI behaviors. Mplus 7.31
(Muthén & Muthén, 2014) was used for all structural equation-modeling
analyses aimed at identifying the best fitting model of the structure of NSSI
to be used in the count-based regression models of NSSI on narcissism and
borderline pathology. We now describe these different analyses in more de-
tail below.
Model Fit for Regressions. Given the non-normal, zero-inflated distribution
of all NSSI behavior count outcomes, six different count-based regression
models (negative binomial, negative binomial hurdle, Poisson, Poisson hur-
dle, zero inflated negative binomial, and zero inflated Poisson), rather than
linear-based regression models, were estimated for each narcissism/BPD-NS-
SI behavior combination. These count-based models are more appropriate
for the current data because the distributions of rare but clinically relevant
symptoms and behaviors commonly include many zeros (Wright, Pincus, &
Lenzenweger, 2012).
The count models differ in terms of the conditional mean and variance
of the outcome variable. Whereas Poisson models assume that both the con-
ditional mean and conditional variance of the distribution are equal, nega-
tive binomial (NB) models do not make this assumption. Rather, NB models
allow the variance to exceed the mean and thus enable the NB distribution
to account for overdispersion in the data. However, when data have far more
zeros (i.e., “excessive” zeros) than can be accounted for by a standard Pois-
son or NB distributional model, a model that can adjust for extra zeros is
needed. A zero-inflated Poisson (ZIP) model is designed for this purpose.
The ZIP regression mixes a distribution degenerate at zero with a Poisson
distribution. However, if the data continue to suggest further overdispersion,
a zero-inflated negative binomial (ZINB) model can be used. The ZINB re-
gression mixes a distribution degenerate at zero with a negative binomial dis-
tribution. An alternative method to analyze count data that display excessive
zero observations are hurdle models, such as the Poisson hurdle (PH) model
and the negative binomial hurdle (NBH) model (see Loeys, Moerkerke, De
FIGURE 1. Observed nonsuicidal self-injury (NSSI) pinching
Smet, & Buysse, 2012). Hurdle models are two-part models that combine a
binary logistic regression model with a zero-truncated (e.g., Poisson or nega-
tive binomial) count model.
In the present study, we examined which of the count-based regression
models (i.e., Poisson, ZIP, PH, NB, ZINB, NHB) best fit our NSSI behavior
count data. Whereas the two nested models—Poisson and NB models—can
be compared using the likelihood ratio tests (LRTs; Long, 1997), zero-in-
flated and hurdle models are non-nested, and therefore require an alterna-
tive test. We used the Vuong (1989) non-nested LRT to compare non-nest-
ed models (ZIP, ZINB, PH, NBH). A significant Vuong statistic favors one
model over the other, and a nonsignificant statistic indicates the two models
are equivalent.
Structural Equation Modeling. We used structural equation modeling (SEM)
to identify the best fitting model of the structure of NSSI to be used in the
narcissism/BPD-latent NSSI factor regression analyses. For all SEM analyses,
a log transformation was used to normalize the distribution of the NSSI
behavior count data, and the robust MLR estimator was used in Mplus to
take into account non-normal data and missing values. We also specified our
indicators as a hurdle model with a normal distribution by using the DATA
TWOPART function in Mplus. Accordingly, all specific NSSI behavior vari-
ables included binary and continuous aspects of the measurement models.
We evaluated the latent structure of 12 NSSI behaviors by specifying
four different confirmatory factor analysis (CFA) models. We used CFA be-
cause we had a priori hypotheses regarding the number and composition of
the factors. We created composite scores for each NSSI behavior domain.
Model 1 was a one-factor in which all 12 NSSI behaviors were represented
by a single factor. Model 2 was composed of two correlated latent factors,
such that the repetitive NSSI latent factor was composed of biting, pinch-
ing, hair pulling, wound picking, rubbing skin against rough surfaces, severe
scratching, hitting or banging the self, and the impulsive NSSI latent factor
was composed of burning, carving, cutting, sticking self with needles, and
swallowing dangerous substances. Model 3 was identical to Model 2 except
that hitting or banging the self was moved to the impulsive NSSI latent fac-
tor. Finally, Model 4 was identical to these two previous models except that
hitting or banging the self was allowed to cross-load onto both latent fac-
tors. We anticipated that a two-factor model would fit our data better than
the one-factor model, but it was unclear which of the alternative two-factor
models would be the best fitting model because research has yielded mixed
findings as to what NSSI category hitting or banging the self best belongs
to (e.g., Kleiman et al., 2015; Mathews et al., 2004). Last, the sample-size
adjusted Bayesian information criterion (BIC) was used for model compari-
sons to select the best fitting model of the structure of NSSI. Lower values
represent better fitting models (Kline, 2005).
Regression Analysis. Last, we performed a series of NBH regression analyses
to examine the effects of pathological narcissism on NSSI behaviors when
accounting for borderline pathology. The first part of the hurdle regression
model tests the effect of predictors (levels of borderline pathology and facets
of pathological narcissism in this case) on the likelihood (i.e., the presence
versus absence) of experiencing an outcome (e.g., self-injury). If the outcome
has occurred, the second part of the hurdle regression model tests the effect
of the predictors on the frequency of experiencing an outcome among those
specific individuals. Hurdle models thus provide separate regression coef-
ficients for the zero versus nonzero and the count part of the model. The
exponentiated coefficients for the zero/nonzero regression can be interpreted
as odds ratios, whereas coefficients in the count regression can be interpreted
as rate ratios. Odds/rate ratios greater than 1 indicate a positive associa-
tion between predictors and outcome variables; values less than 1 indicate
a negative association between the predictor and outcome variables, and an
association near 1 indicates no association.
In our first set of regression analyses, each of the NSSI higher-order do-
main counts was regressed onto all seven PNI scales and the BPQ scale. In
our second set of regression analyses, each specific NSSI behavior count was
regressed onto all seven pathological narcissism facet scales and the BPQ
scale.1 These analyses controlled for shared variance among the predictors.
The results of these analyses are described in further detail in the sections
that follow.
Table 1 provides endorsement rates and descriptive statistics (frequency,
range) on NSSI variables. Although a college student sample was used in this
study, we can see that 35.78% of the total sample reported a history of hav-
ing engaged in any kind of NSSI behavior. Moreover, there was a consider-
able range of psychological distress in this sample, and individuals who had
engaged in NSSI (NSSI group) had significantly more self-reported mental
health problems (e.g., borderline pathology, depression severity, substance
use, psychiatric hospitalizations; see Table 2) than did the non-NSSI group.
There were no statistical differences in demographic variables (e.g., gender,
year in school) between the NSSI group and the non-NSSI group. Moreover,
despite a majority of participants not endorsing NSSI, the endorsement rate
and frequency of NSSI that does exist allows for the prediction of specific
NSSI behaviors.
Results from the LRT tests indicated that in every instance the NB model
fit the data significantly better than its Poisson counterpart. On the other
hand, a comprehensive comparison of the models (i.e., comparing a nested
1. Each specific NSSI behavior count was also regressed on Narcissistic Grandiosity (NG), Narcissistic
Vulnerability (NV), and Borderline Pathology simultaneously in the hurdle regression models. Although
NG and NV (unlike Borderline Pathology) tended to be nonsignificant for most of the results, this did not
appear to be the case when we used facets of NV and NG, suggesting that assessment at the facet level
could be more informative for NSSI predictions.
with a non-nested model; comparing two non-nested models) suggested that,
with a few exceptions, the NB, ZINB, and NBH models were equivalent.
However, several NB and ZINB models were nonidentified. Thus, a hurdle
model with a normal distribution was used when modeling the structure of
NSSI, and a NBH regression model was chosen as the final model to test (a)
whether facets of pathological narcissism predict the presence of higher-or-
der NSSI domains and/or specific NSSI behaviors when accounting for levels
of borderline pathology, and (b) whether those same facets of pathologi-
cal narcissism predict the frequency of higher-order NSSI dimensions and/or
specific individual NSSI behaviors when accounting for levels of borderline
As predicted, Model 2—the two-factor model of repetitive NSSI and impul-
sive NSSI with hitting or banging the self in the repetitive NSSI factor—was
the best-fitting model (BIC = 9120.26; Model 1 BIC = 9147.08, Model 3
BIC = 9131.60, Model 4 BIC = 9123.88). For the preferred CFA model (i.e.,
Model 2),2 repetitive NSSI and impulsive NSSI were correlated .88 (p < .001)
with each other for the binary logistic regression aspect of the hurdle mod-
el, whereas these two higher-order NSSI variables were correlated .63 (p <
.001) with each other for the continuous zero-truncated aspect of the hurdle
model. Based on this selected model, we created two higher-order summary
scores reflecting repetitive NSSI behaviors (biting, pinching, hair pulling,
wound picking, rubbing skin against rough surfaces, severe scratching, and
hitting or banging the self) and impulsive NSSI behaviors (burning, carving,
cutting, sticking self with needles, swallowing dangerous substances). These
TABLE 1. Endorsement Rates and Descriptive Statistics on Nonsuicidal Self-Injury (NSSI) Variables
Behavior Type Endorsement, n (%) Frequency of endorsement Range
Biting 69 (6.74) 2,315 0–500
Burning 44 (4.30) 301 0–75
Carving 18 (1.76) 250 0–100
Cutting 131 (12.81) 3,773 0–400
Hitting or Banging Self 124 (12.12) 4,901 0–750
Pinching 121 (11.83) 7,628 0–1,000
Hair Pulling 111 (10.85) 4,249 0–500
Rubbing Skin† 59 (5.77) 3,139 0–1,000
Severe Scratching 110 (10.75) 4,059 0–500
Sticking Self With Needles 31 (3.03) 922 0–333
Swallowing Substances‡ 25 (2.44) 1,372 0–1,000
Wound Picking 231 (22.58) 47,322 0–10,000
Total NSSI Behaviors 366 (35.78) 80,231 0–10,108
N = 1,023. † = rubbing skin against rough surface; ‡ = swallowing dangerous substances.
2. The factor loadings for the preferred CFA model are available upon request from the first author.
TABLE 2. Demographic and Mental Health Variables Between Individuals With and Without NSSI
NSSI (–) NSSI (+) Effect Size
Variable M SD Mdn Range M SD Mdn Range
% Female 73.20 71.60 c2 = 0.31, ns
Income Rating 3.49 1.55 3.45 1.51 –0.02, ns
Year in School 2.19 1.15 2.07 1.13 –0.10, ns
Psychiatric Symptom and History
Borderline Pathology (BPQ) 15.90 12.09 15.89 .00–61.00 24.12 13.63 22.00 .00–62.00 0.64***
Pathological Narcissism (PNI) 2.43 0.65 2.42 .02–4.23 2.66 0.63 2.69 .74–5.00 0.36***
Antisocial Behaviors (STAB) 47.50 12.21 45.00 31.00–115.00 53.84 13.85 52.00 32.00–117.00 0.49***
Depression Severity (PHQ-9) 5.13 4.86 4.00 .00–27.00 9.03 6.20 8.00 .00–27.00 0.73***
Trauma (PCL-5) 15.32 15.05 11.00 .00–74.00 24.26 18.83 20.50 .00–79.00 0.54***
Drug Use (DAST) 0.15 0.10 .10 .00–.70 0.22 0.17 .20 .00–.90 0.54***
Alcohol Abuse (PROMIS-Alc) 12.96 5.39 12.00 5.00–35.00 14.47 6.06 13.00 7.00–34.00 0.27***
Therapy History (%) 21.33 40.91 c2 = 42.73***
Psychiatric Medication History (%) 8.74 20.23 c2 = 26.52***
Psychiatric Hospitalization History (%) 4.45 8.83 c2 = 7.64**
Note. Percentages for therapy, medication, and hospitalization represent any history (current or past) of use of these services. Unless otherwise noted, effect size is Cohen’s d and is scored such that
positive values indicate higher values for the NSSI (+) group. NSSI = nonsuicidal self-injury (–): absent; (+): present; ns for NSSI (–) ranged from 510 to 657 and for NSSI (+), ns ranged from 312
to 366. Income Ratings based on 1 (under $20,000) to 5 (over $100,000) scale. BPQ = Borderline Personality Questionnaire (Poreh et al., 2006); PNI = Pathological Narcissism Inventory; STAB =
Subtypes of Antisocial Behavior (Burt & Donnellan, 2009); PHQ-9 = Patient Health Questionnaire-9 Depression Scale (Kroenke, Spitzer, & Williams, 2001); PCL-5 = Posttraumatic Stress Disorder
Checklist for DSM-5 (Blevins et al., 2015); DAST = Drug Abuse Screening Test-10 (Skinner, 1982); PROMIS-Alc = Patient-Reported Outcomes Measurement Information System-Alcohol Use Short
Form (Pilkonis et al., 2013). ***p < .001. **p < .01. ns = not statistically significant. Results did not change when non-parametric Mann-Whitney U test was used to make group comparisons.
variables were used as our outcome variables in the following regression
Coefficients and their significance for the NBH model are summarized in
Table 3. Distinct relationships emerge between specific facets of pathological
narcissism and higher-order dimensions of NSSI even when accounting for
levels of borderline pathology. Specifically, Grandiose Fantasy is positively
associated with endorsing repetitive NSSI behaviors, but is not significantly
associated with the frequency of repetitive behaviors. In contrast, Hiding
the Self is related to an increased frequency of repetitive behaviors, but is
not significantly associated with endorsing repetitive NSSI. Finally, Exploit-
ativeness is positively associated with endorsing impulsive NSSI behaviors,
and Entitlement Rage is negatively associated with endorsing impulsive NSSI
behaviors, but neither is associated with their frequency. Additionally, Self-
Sacrificing Self-Enhancement is significantly related to a decreased frequency
of impulsive NSSI, but not with the endorsement of impulsive NSSI.
TABLE 3. Summary of Coefficients From Model Regressing Higher-Order Nonsuicidal Self-Injury
Behavior on Facets of Pathological Narcissism and Borderline Pathology
Negative Binomial Hurdle
Nonsuicidal Self-Injury Domain OR (h) p (h) RR (NB) p (NB)
Repetitive Behavior
EXP 0.980 0.816 0.890 0.473
SSSE 0.975 0.834 1.437 0.088
GF 1.333 0.012 0.708 0.061
CSE 0.960 0.707 0.886 0.567
HS 1.169 0.141 1.625 0.009
DEV 1.016 0.887 1.526 0.060
ER 0.839 0.136 0.877 0.496
BPD 1.040 0.000 1.036 0.011
Impulsive Behavior
EXP 1.276 0.031 0.925 0.719
SSSE 1.078 0.622 0.500 0.028
GF 1.058 0.622 1.325 0.247
CSE 1.209 0.165 0.670 0.127
HS 1.020 0.887 1.244 0.272
DEV 0.942 0.682 1.135 0.580
ER 0.683 0.009 0.819 0.434
BPD 1.068 0.000 1.070 0.000
Note. OR = odds ratio; RR = rate ratio; h = hurdle class; NB = negative binomial. EXP = exploitativeness; SSSE =
self-sacrificing self-enhancement; GF = grandiose fantasies; CSE = contingent self-esteem; HS = hiding the self; DEV =
devaluing; ER = entitlement rage; BPD = borderline personality disorder. All values are standardized. Boldface indicates
p < .05.
We examined the same model described in Table 3, but this time separate-
ly regressing specific NSSI behaviors, rather than latent NSSI behavior do-
mains, on facets of pathological narcissism while accounting for borderline
pathology. Table 4 presents these findings.
Facets of Grandiosity. Exploitativeness is positively associated with endors-
ing burning, but not with its frequency. Self-Sacrificing Self-Enhancement is
significantly associated with an increased frequency of wound picking, but
not its endorsement. Grandiose Fantasy is positively associated with endors-
ing hitting or banging the self and negatively associated with endorsing both
swallowing dangerous substances and wound picking, but not their frequen-
cy. Grandiose Fantasy is also associated with a decreased frequency of biting,
hair pulling, severe scratching, and an increased frequency of carving, if these
behaviors were endorsed.
Facets of Vulnerability. Contingent Self-Esteem is negatively associated with
endorsing biting, but positively associated with its frequency if endorsed.
Hiding the Self is positively associated with endorsing severe scratching, as
well as an increased frequency of pinching and a decreased frequency of
carving, if these behaviors were endorsed. Devaluing is positively associated
with endorsing pinching, and an increased frequency of carving and wound
picking. Finally, Entitlement Rage was negatively associated with endorsing
carving, cutting, hitting or banging self, pinching, and severe scratching, but
not their frequency if endorsed. Entitlement Rage was also associated with a
decreased frequency of biting if endorsed.
This is the first study to examine associations between distinct facets of
pathological narcissism and specific nonsuicidal self-injury (NSSI) behaviors
using hurdle regression models. All seven facets of pathological narcissism
were associated with NSSI behaviors, but in varying ways, even when ac-
counting for levels of borderline pathology in the undergraduate sample.
Thus, these results highlight the usefulness of the facet-level assessment of
pathological narcissism.
Overall, findings supported our hypothesis in showing that when lev-
els of BPD are accounted for, facets of both narcissistic vulnerability and
grandiosity are associated with various NSSI behaviors. Relative to facets of
narcissistic grandiosity, facets of narcissistic vulnerability were more often
significantly associated with both the presence and increased frequency of
specific NSSI behaviors (Table 4), providing further support for narcissis-
tic vulnerability–NSSI associations (Miller et al., 2010; Pincus et al., 2009;
Thomas et al., 2012). Whereas other studies found mixed evidence link-
ing narcissistic grandiosity and NSSI, our findings demonstrated that certain
facets of narcissistic grandiosity (e.g., Grandiose Fantasy) are significantly
TABLE 4. Summary of Coefficients from Model Regressing Specific Self-Injury Behavior on Facets of
Pathological Narcissism and Borderline Pathology
Negative Binomial Hurdle
Nonsuicidal Self-Injury Behavior OR (h) p (h) RR (NB) p (NB)
EXP 1.211 0.243 0.686 0.235
SSSE 0.915 0.684 2.252 0.123
GF 1.049 0.816 0.388 0.007
CSE 0.652 0.032 2.614 0.008
HS 1.353 0.126 1.391 0.337
DEV 1.475 0.074 1.580 0.197
ER 0.722 0.139 0.305 0.001
BPD 1.044 0.000 0.989 0.565
EXP 1.530 0.035 0.442 0.307
SSSE 0.746 0.280 1.158 0.913
GF 1.137 0.620 0.480 0.570
CSE 1.254 0.347 3.822 0.085
HS 0.911 0.701 0.735 0.537
DEV 1.048 0.857 1.314 0.656
ER 0.748 0.259 0.918 0.923
BPD 1.080 0.000 1.038 0.240
EXP 1.272 0.412 0.671 0.290
SSSE 0.959 0.918 0.645 0.229
GF 1.280 0.512 2.103 0.046
CSE 1.036 0.919 0.669 0.199
HS 0.597 0.166 0.216 0.005
DEV 1.535 0.292 5.844 0.010
ER 0.431 0.033 0.637 0.304
BPD 1.083 0.000 1.002 0.945
EXP 1.131 0.317 1.175 0.534
SSSE 1.051 0.770 0.501 0.059
GF 1.008 0.959 1.345 0.331
CSE 1.234 0.161 0.800 0.515
HS 1.208 0.203 1.458 0.094
DEV 0.785 0.133 1.103 0.687
ER 0.660 0.009 0.685 0.194
BPD 1.073 0.000 1.047 0.017
Hitting or Banging Self
EXP 1.048 0.707 1.240 0.351
SSSE 0.983 0.922 2.137 0.069
GF 1.507 0.012 0.935 0.839
CSE 0.855 0.300 1.694 0.074
HS 0.942 0.697 1.066 0.841
DEV 1.379 0.052 0.838 0.610
ER 0.708 0.036 0.603 0.091
BPD 1.059 0.000 1.038 0.038
EXP 1.118 0.377 1.283 0.339
SSSE 1.032 0.856 0.724 0.416
GF 1.250 0.170 0.784 0.456
CSE 0.972 0.853 1.764 0.079
HS 1.049 0.754 1.679 0.046
DEV 1.403 0.040 1.048 0.872
ER 0.645 0.009 0.596 0.059
BPD 1.042 0.000 1.050 0.005
Hair Pulling
EXP 0.980 0.872 0.853 0.434
SSSE 1.239 0.234 1.902 0.096
GF 1.007 0.965 0.405 0.002
CSE 0.906 0.530 1.187 0.561
TABLE 4.(continued)
Negative Binomial Hurdle
Nonsuicidal Self-Injury Behavior OR (h) p (h) RR (NB) p (NB)
HS 1.206 0.231 1.628 0.057
DEV 1.064 0.712 0.835 0.501
ER 0.813 0.216 0.870 0.595
BPD 1.059 0.000 1.005 0.790
Rubbing Skin†
EXP 1.191 0.298 1.152 0.814
SSSE 1.034 0.887 0.455 0.447
GF 0.813 0.338 0.928 0.919
CSE 0.953 0.818 4.290 0.071
HS 1.477 0.053 1.099 0.887
DEV 1.022 0.917 0.715 0.618
ER 1.087 0.700 0.793 0.792
BPD 1.046 0.000 0.979 0.396
Severe Scratching
EXP 1.129 0.354 0.823 0.389
SSSE 0.810 0.233 1.544 0.196
GF 1.082 0.635 0.532 0.017
CSE 1.080 0.628 1.156 0.622
HS 1.479 0.013 1.145 0.619
DEV 1.159 0.378 1.204 0.575
ER 0.711 0.044 1.455 0.140
BPD 1.047 0.000 0.989 0.552
Sticking Self With Needles
EXP 1.441 0.111 0.770 0.671
SSSE 0.956 0.886 0.899 0.928
GF 0.861 0.606 0.802 0.745
CSE 0.785 0.381 0.445 0.121
HS 0.978 0.936 0.567 0.589
DEV 1.156 0.634 5.778 0.120
ER 0.861 0.624 0.786 0.770
BPD 1.083 0.000 1.052 0.145
Swallowing Substances‡
EXP 1.502 0.134 0.575 0.602
SSSE 1.303 0.471 3.123 0.608
GF 0.511 0.044 0.676 0.620
CSE 1.179 0.611 0.177 0.154
HS 0.877 0.667 0.964 0.963
DEV 0.658 0.210 2.920 0.138
ER 1.154 0.675 7.246 0.176
BPD 1.061 0.001 1.089 0.047
Wound Picking
EXP 1.502 0.666 0.575 0.944
SSSE 1.303 0.261 3.123 0.036
GF 0.511 0.048 0.676 0.284
CSE 1.179 0.948 0.177 0.052
HS 0.877 0.094 0.964 0.111
DEV 0.658 0.847 2.920 0.024
ER 1.154 0.842 7.246 0.558
BPD 1.061 0.000 1.089 0.087
Note. OR = odds ratio; RR = rate ratio; h = hurdle class; NBH = negative binomial hurdle. EXP = exploitativeness;
SSSE = self-sacrificing self-enhancement; GF = grandiose fantasies; CSE = contingent self-esteem; HS = hiding the
self; DEV = devaluing; ER = entitlement rage; BPD = borderline personality disorder. † = rubbing skin against rough
surface; ‡ = swallowing dangerous substances. All values are standardized. Boldface indicates p < .05.
related to specific NSSI behaviors and to specific higher-order NSSI domains.
Moreover, the fact that most facets of narcissistic vulnerability and grandios-
ity were associated with the endorsement and frequency of NSSI behaviors,
even after controlling for borderline pathology, supports the view that both
expressions of pathological narcissism are important in understanding self-
harming behaviors. Individuals higher in pathological narcissism have high
expectations for themselves and others, but also rely on others for self and
emotional regulation (e.g., Pincus, 2013; Pincus, Roche, & Good, 2015).
Thus, such individuals may be more likely to engage in NSSI behaviors in
response to self-enhancement failures and the lack of needed recognition or
admiration from others (Blasco-Fontecilla et al., 2010; Pincus, Dowgwillo,
& Greenberg, 2016).
Several distinct patterns emerged when specific NSSI behaviors were
grouped under the two higher-order domains of repetitive NSSI and impul-
sive NSSI. Notably, distinct facets of narcissistic grandiosity and vulnerabil-
ity were associated with both repetitive and impulsive NSSI behaviors. For
instance, Grandiose Fantasy was positively associated with the presence of
repetitive NSSI behaviors. This result makes sense given that individuals ele-
vated on this narcissistic feature are likely to retreat into their private worlds
to cope with negative affect and dysregulation associated with narcissistic
injuries (e.g., Pincus, 2013; Pincus, Cain, & Wright, 2014). Once dysregu-
lated, Grandiose Fantasy in the service of self-enhancement (see Schoenleber
& Berenbaum, 2012) is negatively associated with NSSI frequency, while
continued social isolation (Hiding the Self) is positively associated with fre-
quency. In contrast, Exploitativeness was positively associated with the en-
dorsement of impulsive NSSI behaviors. Exploitativeness is a highly inter-
personal facet of narcissism, and this suggests that episodic social triggers
may be particularly problematic for narcissistic individuals, possibly evoking
impulsive NSSI behaviors.
We believe it is efficient and useful to examine NSSI at the latent level
(i.e., repetitive vs. impulsive) because the data appear to conform well to a
two-factor solution, and focusing on these dimensions produces theoreti-
cally coherent results. Nevertheless, there is still value in focusing on specific
forms of NSSI behaviors to capture some nuances that might otherwise be
missed. For instance, although Devaluing was not significantly associated
with the endorsement or frequency of repetitive or impulsive behaviors when
accounting for levels of borderline pathology, this facet of narcissistic vulner-
ability was particularly associated with the increased frequency of carving on
the skin with a sharp object if it was endorsed. One reason why Devaluing
may be so strongly related to some NSSI behaviors is that it not only reflects
the dismissal of others, but also has a strong component of devaluing the
self that involves self-criticism and shame for needing recognition and ad-
miration from disappointing others. Thus, narcissistic individuals may be
more likely to engage in various forms of NSSI to punish themselves when
they experience frustrations and disappointment over these unmet needs. In
contrast to those who experience self-criticism and shame, individuals who
experience anger (Entitlement Rage) evoked by unmet entitled expectations
of others’ interest, attention, and admiration may be less likely to engage in
NSSI as their negative affect is directed toward others rather than the self.
Although the underlying motivations for suicide and self-harm are different,
there is research indicating they are related to each other. Engaging in NSSI
increases the risk for suicide attempts (Bryan, Bryan, May, & Klonsky, 2015;
Guan, Fox, & Prinstein, 2012), increases the lethality of suicide attempts
(Andover & Gibb, 2010), and increases the risk of completed suicides (Coo-
per et al., 2005; Hawton, Zahl, & Weatherhall, 2003). The present study
found that facets of both narcissistic vulnerability and narcissistic grandiosi-
ty are related to the endorsement and frequency of NSSI behaviors even after
accounting for levels of borderline pathology. These findings underscore the
importance of assessing the full range of manifestations of pathological nar-
cissism and corroborate clinical conceptualizations of suicidality in narcis-
sistically disturbed individuals as a process reflecting the interplay of grandi-
osity and vulnerability. For example, clinical observations show that patients
with a combination of affect dysregulation and pathological narcissism may
respond to interpersonal stress with unexpected, potentially deadly, self-de-
structive behaviors (Blasco-Fontecilla et al., 2010; García-Nieto et al., 2014;
Pincus et al., 2014, 2016). Such behaviors may be an effort to protect the
self from negative affect (e.g., shame, rage) associated with loss, defeat, and
narcissistic injury while simultaneously giving the narcissistic individual the
feelings of invulnerability and mastery over his or her own life (Ronningstam
& Malstberger, 1998; Stone, 1989). Thus, in addition to routine monitor-
ing for suicidality (Links & Prakash, 2014), the current results indicate the
potential benefits of monitoring for NSSI as well.
This study has several limitations that should be taken into consideration
when interpreting the findings. One potential limitation of this study is that
the sample was a fairly homogenous group of college students. However, this
concern may be mitigated by the fact that self-injurious behaviors are rela-
tively common in college samples, and the prevalence of self-reported history
of NSSI in the current study’s sample was higher or similar to that observed
in other studies of self-harm among college students (e.g., Gratz, 2001; Whit-
lock et al., 2006, 2011). Further, although caution must be exercised in gen-
eralizing our findings to clinical populations, the fact that our NSSI group
self-reported greater severity of mental health problems (e.g., borderline pa-
thology, depression severity, see Table 2) than the non-NSSI group suggests
to us that this sample provides useful insights into how pathological narcis-
sism is associated with NSSI. Nevertheless, research should replicate and
extend our findings in diverse clinical (e.g., inpatient, outpatient) and other
nonclinical (e.g., community) samples, and consider taking into account the
co-occurrence of other mental health problems beyond borderline pathology
that are linked with NSSI. A second limitation is that data were based solely
on self-report questionnaires. Future studies should consider the inclusion of
standardized clinical interviews for NSSI (e.g., Gratz, Dixon-Gordon, Chap-
man, & Tull, 2015; Linehan, Comtois, Brown, Heard, & Wagner, 2006;
Nock, Holmberg, Photos, & Michel, 2007) and pathological narcissism
(e.g., Gunderson, Ronningstam, & Bodkin, 1990; Loranger et al., 1994).
However, respondents may be more likely to report pathological, embarrass-
ing, or shameful behaviors on anonymous self-report measures than in face-
to-face interviews (e.g., Kaplan et al., 1994; Keel, Crow, Davis, & Mitchell,
2002; Locke & Gilbert, 1995). Finally, given the cross-sectional design of
this study, future work is needed to prospectively examine the presence and
frequency of NSSI behaviors in individuals high in pathological narcissism.
Despite its limitations, the present study found pathological narcissism
was related to self-reported endorsement and frequency of NSSI behaviors
even after accounting for levels of borderline pathology among a large sample
of undergraduate students. Our results show that facets of both narcissistic
vulnerability and narcissistic grandiosity differ in their associations with spe-
cific NSSI behaviors and higher-order (repetitive and impulsive) NSSI behav-
iors. Also important is that this study used statistical models appropriate for
highly skewed count distributions typical for rare clinical events, methods
that were not used in other correlational studies examining narcissism–NSSI
associations. Not only do the current findings extend understanding of the
link between narcissistic pathology and NSSI, they also support the use of
lower-order facets of pathological narcissism. The current results also point
to possible psychological and interpersonal mechanisms linking pathological
narcissism and NSSI. Future research into the contexts and motivations for
NSSI in narcissistic individuals is needed.
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... Higher vulnerability participants swallowed dangerous substances with more frequency than lower vulnerability participants, and higher grandiosity participants were more likely to have burned themselves than lower grandiosity participants. Prior work (Dawood et al., 2018) has also found a relationship between grandiosity (specifically, exploitativeness) and the presence of self-burning, suggesting that grandiosity is consistently associated with this less common and more extreme form of NSSI (Swannell et al., 2014). Of note, although not meeting conventional thresholds of significance once multiple comparison corrections were completed, grandiosity was associated with the presence of 8 out of 12 methods of NSSI-a distinct pattern that was not present for either vulnerability or narcissistic fluctuation. ...
... This raises the question of whether prior research reporting strong relationships between vulnerability and NSSI may have been detecting the influence of unmeasured BPD symptoms, and it encourages future researchers to consider the role of this common comorbidity. Indeed, the only prior work to control for BPD when modeling the narcissism-NSSI relationship (Dawood et al., 2018) similarly found few positive relationships between vulnerable narcissism and NSSI engagement. As with narcissistic vulnerability, in the present work narcissistic fluctuation was highly correlated with BPD and markedly higher in the NSSI group than in the non-NSSI group. ...
... . To illustrate, we consider if the significance threshold was dropped from p < .05 to p < .01 inDawood et al.'s (2018) binomial hurdle models regressing specific NSSI methods on facets of narcissism. The only positive relationship between narcissism facets and NSSI presence or frequency to remain is contingent self-esteem predicting frequency of biting. ...
The present study examines whether dimensions of pathological narcissism are associated with the presence, frequency, and function of nonsuicidal self-injury (NSSI). Adults (N = 252) completed questionnaires assessing narcissistic grandiosity, narcissistic vulnerability, fluctuation between these narcissistic states, and borderline personality disorder (BPD) symptoms. Those with a history of NSSI (n = 105) also reported the method, frequency, and function of their NSSI engagement. When controlling for co-occurring BPD symptoms, there were very few associations between vulnerability, grandiosity, and narcissistic fluctuation and NSSI presence and frequency. However, a clear pattern emerged regarding NSSI functions. Although vulnerability and narcissistic fluctuation were not associated with any functions of NSSI when co-occurring BPD symptoms were controlled for, grandiosity was positively associated with all interpersonal functions of NSSI (e.g., peer bonding, revenge) and negatively associated with the intrapersonal function of affect regulation. These results suggest a unique relationship between narcissistic grandiosity and NSSI that may inform clinical intervention.
... This has been most extensively studied with depressive symptoms(Ellison, Levy, Cain, Ansell, & Pincus, 2013;Erkoreka & Navarro, 2017;Kealy, Tsai, & Ogrodniczuk, 2012; Marčinko et al., 2014;Morf et al., 2017;Tritt, Ryder, Ring, & Pincus, 2010). In addition, narcissistic grandiosity and vulnerability are associated with suicide attemptsPincus et al., 2009), suicidal ideation(Jaksic, Marcinko, Hanzek, Rebernjak, & Ogrodniczuk, 2017), and non-suicidal self-injury(Dawood, Schroeder, Donnellan, & Pincus, 2018). ...
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.
... Results indicating that narcissistic vulnerability shows positive associations with treatment utilization support prior evidence that patients with narcissistic traits possibly present for mental health services when their vulnerable self-state becomes predominant [21]. In addition, PNI vulnerability and PNI grandiosity are both associated with suicidal ideation and suicide attempts [7,22,23], and non-suicidal self-injury [24]. ...
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Background: The Pathological Narcissism Inventory (PNI) is a multidimensional measure developed to assess narcissistic grandiosity and narcissistic vulnerability. We aimed to validate the Arabic version of the original Pathological Narcissistic Inventory (PNI) and its brief form (B-PNI) in a community sample of Lebanese adults. Methods: The English language PNI items were translated into Arabic following a rigorous translation, back-translation, and linguistic evaluation. A total of 401 participants were administered the translated PNI, as well as previously validated Arabic versions of the Big Five Inventory-2, the Rosenberg Self-esteem Scale, the Patient Health Questionnaire (PHQ-9), and the Impulsivity-8 Scale. Results: Exploratory and confirmatory analyses supported the existence of seven first-order and two second-order factors of the PNI and B-PNI. Except for exploitativeness where females scored lower than males, no other significant differences by gender were observed for the remaining PNI subscale scores. Additionally, scores on all the subscales exhibited good reliability, while the associations with external measures supported the concurrent validity of the translated instrument. Conclusion: The results of this study suggest that scores on the PNI and B-PNI are highly reliable with satisfactory concurrent and factorial validity, providing an assessment of broadly defined pathological narcissism among the Lebanese young adult population. The availability of the Arabic PNI and its brief form should facilitate improved understanding of pathological narcissism in Arabic cultures and the different factors that govern narcissistic personality pathology.
... This failure is often accompanied by negative emotions (Miller et al., 2011). To reduce the negative state, vulnerable narcissists tend to employ dysfunctional coping strategies that can include both self-harming behavior such as self-hitting and cutting (Dawood, Schroder, Donnellan, & Pincus, 2018), and problematic drinking and gambling (Bilevicius et al., 2019;Welker et al., 2019). It is likely that SM provide them with a less harmful alternative to escape the negative emotions of failure Casale & Fioravanti, 2018). ...
... Vulnerability does not count as constitutive for the clinical diagnosis of pathological narcissism, since pathological narcissism is phenomenally not associated with low self-esteem. Nevertheless, vulnerability finds expression in a higher than average tendency of harming oneself (8), in suicide ideation (9), addictions (10), especially substance abuse [e.g., alcohol (11)]. This fact, together with a marked discrepancy between a positive future-orientation and an overall negative outlook (12) amounts to a an intrinsic vulnerability factor in NPD. ...
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In this paper, I distinguish three different levels for describing, and three corresponding ways for understanding, deficient empathy as the core of NPD (Narcissistic Personality Disorder). On the macro level, deficient empathy can be explained as disturbed interpersonal functioning, and is understood as lack of recognition. On the meso-level, deficient empathy can be described as psychic disintegration, and can be understood specifically in its dissocial aspects. Psychic disintegration in NPD correlates with somatic changes, i.e., dysfunctional affective empathy and mind-reading on the micro level of description, which is the third level. The “core-deficit-model of NPD” that I outline, while not rejecting reductionist approaches outright, argues in favor of integrating (top-down/bottom-up) functionalist descriptions of empathy into a wider conceptual framework of bio-psycho-social functioning. The “core-deficit-model of NPD” is interdisciplinary, can bypass monodisciplinary skepticism, and removes purported barriers between explaining and understanding the “lack” of empathy as the core of pathological narcissism.
... Perhaps woman high in pathological narcissism are highly sensitive to ego threat and disappointment, but if they have abuse histories, this sensitivity leads to increased internalizing rather than externalizing behaviors. It is notable that beyond aggression, pathological narcissism is also positively associated with depression and self-harm Dawood, Schroeder, Donnellan, & Pincus, 2018). Other studies report similar gendered associations between child abuse and personality. ...
This study examines the moderating effects of gender, child abuse, and pathological nar-cissism on self-reported stalking, sexual harassment, intimate partner violence, and sexual aggression in undergraduate men and women. Child abuse was positively associated with engaging in all forms of interpersonal violence for both genders. For women, pathological narcissism moderated this association such that higher levels of pathological narcissism reduced the association between child abuse and engaging in stalking, sexual harassment , sexual aggression. For men. pathological narcissism exhibited independent positive associations with engagement in sexual harassment and sexual aggression and a negative association with engagement in intimate partner violence, but no moderating effects. These gender differences have important implications for the assessment of women's violence, and university violence prevention and advocacy programs.
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Personality disorders (PDs) are severe mental issues, while the information in the common population is not comprehensively identified worldwide. We aimed to study the prevalence of personality disorders, their sociodemographic correlates, and their comorbidity with psychiatric disorders in the general population of Iranian adults. We used the Millon Clinical Multiaxial Inventory-Third Edition (MCMI-III) in a survey of 48083 adults. We selected the samples through a multistage random cluster sampling method and used descriptive statistics and binary logistic regression analysis methods to analyze the gathered data. The overall prevalence of PDs in Iranian people was 18.3. Cluster C PDs (9.86%) were more common than Cluster B (5.52%) and Cluster A PDs (1.94%). Compulsive (7.4%), negativistic (3.7%), depressive (3.4%), histrionic (2.7%), and masochistic (2.1%) PDs were among the most prevalent. The prevalence of other PDs was low (⩽1.7%). PDs were more prevalent in the female gender and in urban areas. The prevalence of PDs decreased with increasing the educational level except for histrionic and narcissistic PDs that significantly increased. Dysthymia (47.4%), anxiety (34.7%), and somatoform (30.6%) were respectively the most common comorbid, and alcohol dependence (3.3%) was the least common comorbid psychiatric disorders with PDs. Dysthymia was also the most comorbid psychiatric disorder in each cluster PDs. Nearly one in five Iranian people was identified with a PD that is located at the high end of the range of international estimates for PDs.
Manipulation of the skin is ubiquitous in most individuals along a spectrum of extent and severity. Skin picking that results in clinically evident changes or scarring to the skin, hair, and nails or significantly impairs intrapsychic, psychosocial, or occupational function is considered pathological picking. Several psychiatric conditions are associated with skin picking, including obsessive-compulsive disorder, body-focused repetitive behaviors, borderline personality disorder, and depressive disorder. It is also associated with pruritus and other dysesthetic disorders. Although pathologic skin picking, also known as excoriation disorder, is a distinct diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM5), this review attempts to further classify the diagnosis into the following eleven picker categories: organic/dysesthetic, obsessive-compulsive, functionally autonomous/habit, anxious/depressed, attention deficit hyperactivity disorder, borderline, narcissistic, body dysmorphic, delusional, guilty, and angry picker. An organized conceptualization of skin picking can guide providers towards a constructive management approach, ultimately increasing the likelihood of successful therapeutic outcomes.
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Grandiose narcissistic traits refer to exploitative and arrogant attitudes, while vulnerable narcissistic traits entail hypersensitivity to judgment and low self-esteem. Little is known about how individuals with narcissistic traits can improve their attitudes toward themselves and others. The current research puts self-and other compassion forward as possible targets to alleviate some of destructive patterns of narcissism. Generally, self-compassion (SC) has previously been associated with beneficial effects on psychological wellbeing, while other compassion (OC) is advantageous for interpersonal relationships. This study explored the relationship between narcissistic traits and the efficacy of experimental compassion inductions. Student and community participants (N = 230, M age = 27.41, 65.2% female) completed grandiose and vulnerable narcissistic trait, SC and OC state questionnaires, and either an SC or OC induction. It was expected that individuals with higher narcissistic traits (particularly grandiose traits) would benefit from the inductions and show higher SC after but would have greater difficulty showing meaningful increases in OC (especially OC directed at the general population). The results indicated that individual differences in grandiose and vulnerable narcissistic traits are related to the magnitude of improvements following the inductions: the theorized lack of SC in individuals with vulnerable oversensitivity to judgment traits seems possible to be counteracted through different types of compassion exercises. Moreover, higher grandiose exploitativeness-entitlement and global vulnerable narcissistic traits related to less increases than others. However, directly inducing OC in individuals with these traits was linked to greater OC improvements than improvements after inducing SC. Overall, the present findings suggest that self-compassionate behavior can be improved in individuals with high oversensitivity and that other compassionate behavior could potentially be increased if, specifically, other compassion exercises are utilized when higher levels of certain narcissistic traits are present.
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The DSM–5 Section III alternative model for personality disorders (AMPD) distinguishes general personality impairment from trait-based descriptions of personality disorder expression. The inclusion of the AMPD in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM–5) provides a scaffold for classification and diagnosis of personality pathology that merits further efforts to improve upon its assessment framework. Recent empirical work focuses on evaluating the reliability and validity of the Level of Personality Functioning Scale and the Personality Inventory for the DSM–5, demonstrating the structural and predictive distinctiveness of measures of pathological personality traits and impairment, evaluating practitioner acceptance and clinical utility, and examining associations with other important outcomes. To complement the increased research on the AMPD, this article focuses on the relevance of distinguishing levels of personality functioning and pathological personality traits in clinical practice. We present three cases of patients exhibiting pathological narcissism that vary in terms of severity of general personality dysfunction and prominent pathological personality traits assessed through the DSM–5 AMPD. We demonstrate that the DSM–5 AMPD provides the clinician with diagnostic criteria that exhibit greater fidelity with the varied presentations of pathological narcissism seen in clinical practice. We conclude that the DSM–5 AMPD provides a useful framework for incorporating different clinical presentations of narcissistic grandiosity, as well as characteristics of narcissistic vulnerability into the diagnosis of narcissistic personality disorder. Finally, we suggest that the clinical relevance of pathological traits in psychotherapy differs as a function of severity of personality impairment.
This entry reviews how narcissistic personality disorder ( NPD ) came to be included and revised through the various iterations of the DSM . Features of NPD ; its prevalence, stability, and comorbidity with other disorders; and its discriminant validity are summarized. These features are impacted by the narrow focus on narcissistic grandiosity in the DSM NPD diagnostic criteria, which lack content reflecting narcissistic vulnerability. Low prevalence rates and a modest body of clinical research first led to a proposed deletion of NPD in the initial DSM ‐5 proposal, followed by a revised NPD description in a revised NPD proposal that mentioned both grandiose and vulnerable themes. The personality disorder proposal was rejected, and the DSM‐IV PD taxonomy was retained in DSM ‐5 . The consequence of this rejection was that the PD section is the only one not to reflect any of the last two decades of scientific advancements since the DSM was updated previously in 1994. As such, this entry provides a review of narcissism as it is currently diagnosed (exactly as in DSM‐IV ) and a discussion on future directions to improve the validity and clinical utility of NPD .
The Pathological Narcissism Inventory (PNI) is a multidimensional measure for assessing grandiose and vulnerable features in narcissistic pathology. The aim of the present research was to construct and validate a German translation of the PNI and to provide further information on the PNI's nomological net. Findings from a first study confirm the psychometric soundness of the PNI and replicate its seven-factor first-order structure. A second-order structure was also supported but with several equivalent models. A second study investigating associations with a broad range of measures (DSM Axis I and II constructs, emotions, personality traits, interpersonal and dysfunctional behaviors, and well-being) supported the concurrent validity of the PNI. Discriminant validity with the Narcissistic Personality Inventory was also shown. Finally, in a third study an extension in a clinical inpatient sample provided further evidence that the PNI is a useful tool to assess the more pathological end of narcissism.
Individuals with a severe mental illness frequently have substance abuse and dependence problems, placing them at increased risk for poor treatment outcome. However, the reliability and validity of self-report measures assessing substance abuse and dependence remains understudied in this population. This investigation evaluates 2 versions of the Drug Abuse Screening Test (DAST; H. Skinner, 1982) as screening tools for an outpatient psychiatric sample. Participants were 73 men and 24 women who had been receiving treatment at a public psychiatric facility. All participants completed the DAST along with other measures of substance use and psychiatric status. The DAST demonstrated adequate internal consistency and temporal stability in this sample. Factor analysis supports a multidimensional scale. We evaluated criterion-related, concurrent and discriminant evidence for validity, and we have concluded that both tested versions of the DAST have sound psychometric properties when used with psychiatric outpatients. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The Posttraumatic Stress Disorder Checklist (PCL) is a widely used DSM-correspondent self-report measure of PTSD symptoms. The PCL was recently revised to reflect DSM-5 changes to the PTSD criteria. In this article, the authors describe the development and initial psychometric evaluation of the PCL for DSM-5 (PCL-5). Psychometric properties of the PCL-5 were examined in 2 studies involving trauma-exposed college students. In Study 1 (N = 278), PCL-5 scores exhibited strong internal consistency (α = .94), test-retest reliability (r = .82), and convergent (rs = .74 to .85) and discriminant (rs = .31 to .60) validity. In addition, confirmatory factor analyses indicated adequate fit with the DSM-5 4-factor model, χ(2) (164) = 455.83, p < .001, standardized root mean square residual (SRMR) = .07, root mean squared error of approximation (RMSEA) = .08, comparative fit index (CFI) = .86, and Tucker-Lewis index (TLI) = .84, and superior fit with recently proposed 6-factor, χ(2) (164) = 318.37, p < .001, SRMR = .05, RMSEA = .06, CFI = .92, and TLI = .90, and 7-factor, χ(2) (164) = 291.32, p < .001, SRMR = .05, RMSEA = .06, CFI = .93, and TLI = .91, models. In Study 2 (N = 558), PCL-5 scores demonstrated similarly strong reliability and validity. Overall, results indicate that the PCL-5 is a psychometrically sound measure of PTSD symptoms. Implications for use of the PCL-5 in a variety of assessment contexts are discussed.