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Bridging the evidence-based gap: From pathological narcissism to narcissism survivors

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Abstract

Psychological evidence-based research on narcissism has traditionally been divided into two main streams: Social-personality psychology focusing on Trait Narcissism (Campbell & Foster, 2007; Morf & Rhodewalt, 2010) and clinical psychology and psychiatry studying psychopathology of Narcissistic Personality Disorder (NPD) (American Psychiatric Association, 2013). As a result, theory-rich clinical frameworks have been separated from data-rich empirical approaches in social-personality psychology, leading to inevitable conceptual confusion (Campbell & Miller, 2011). Clinically oriented theorists have been emphasizing narcissistic vulnerability whilst social-personality researchers have centred around narcissistic grandiosity which ironically have become the focus of NPD diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013). Whilst significant attempts were made to marry diverse groups of narcissism researchers and clinicians, startling gaps in evidence-based research on narcissism and familial concepts keep being brought into light to this day (Day, Bourke, Townsend, & Grenyer, 2019a; Miller et al., 2017). That is, conceptual dealings around narcissism in evidence based psychology seemed to have left devastating experiences of Narcissism Survivors unattended, which, not surprisingly, have been well captured world widely by advocacy and self-help community (Hintjens, 2015; Manne, 2015; Manson, 2019; Narcissist Abuse Support, 2019; Patients Like Me, 2019; Reddit, 2013; World Narcissistic Abuse Awareness Day (WNAAD), 2019). This article provides a brief history of the concept of narcissism and outlines the evidence-based research gap pertaining to narcissism survivors as well as most current and future research endeavours. The article concludes with a case study which offers a graphic example of pathological narcissism and its impact on narcissism targets in the context of romantic relationships.

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It appears very likely that it is the convergence of at least some, if not all, of 6 elements, massive defect of affect defense, the defect in value formation, the hyposymbolization, the desperate search for an object substitute, the intensely self destructive qualities, and the search for regressive gratification, together with the intensity of the underlying narcisstic conflicts that forms the predispositional constellation for the 'addictive illness' in general and for compulsive drug use in particular. It appears that the most specific of these predispositional factors are the need for affect defense and the compelling wish for regressive gratification; but only further research, including predictive studies, can elucidate the relative relevance of these 6 factors. The specific reason is the mobilization of the underlying narcisstic conflict. The precipitating reason is the advent of the drug on stage. Some or all of the 6 predispositional factors described may be necessary reasons.
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This study describes the construction of scales designed to assess ambitious-narcissistic character style on three projective tests: the Early Memories, TAT, and Rorschach. The main aim of the study was to evaluate the reliability and validity of these scales. A secondary aim was to demonstrate the feasibility of assessing particular character styles with projective tests commonly available to clinicians and researchers. Forty male college students volunteered as subjects. The overall reliability of the three projective scales was found to be acceptable. The scales were then tested for validity in two ways. First, they were intercorrelated and found to show a pattern suggesting a common dimensionality. Secondly, the scales were found to successfully differentiate subjects rated by clinically-trained raters as ambitious-narcissistic in style from those subjects rated as non-ambitious-narcissistic.
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This review documents two themes of emphasis found in phenotypic descriptions of pathological narcissism across clinical theory, social/personality psychology, and psychiatric diagnosis. Clinical theories of narcissism spanning 35 years consistently describe variations in the expression of pathological narcissism that emphasize either grandiosity or vulnerable affects and self-states. Recent research in social/personality psychology examining the structure of narcissistic personality traits consistently finds two broad factors representing Grandiosity-Exhibitionism and Vulnerability-Sensitivity-Depletion respectively. However, the majority of psychiatric criteria for narcissistic personality disorder (NPD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) emphasize expressions of grandiosity. By placing most of the diagnostic emphasis on overt grandiosity, DSM NPD has been limited by poor discriminant validity, modest levels of temporal stability, and the lowest prevalence rate on Axis II. Despite converging support for two phenotypic themes associated with pathological narcissism, psychiatric diagnosis and social/personality psychology research often focus only on grandiosity in the assessment of narcissism. In contrast, clinical theory struggles with a proliferation of labels describing these broad phenotypic variations. We conclude that the construct of pathological narcissism is at a crossroads and provide recommendations for diagnostic assessment, clinical conceptualization, and future research that could lead to a more integrated understanding of narcissistic personality and narcissistic personality pathology.
Diagnostic and statistical manual of mental disorders
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.