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Can narcissism be considered a risk factor for suicidal thoughts and behaviors? A systematic review of the literature

Authors:

Abstract

Introduction Although suicide showed an association with personality disorders, few studies focused on narcissism. This association is interesting, especially in what authors called a “narcissism epidemic”, considering narcissistic wounds to which subjects could be subjected. Objectives To systematically review studies investigating the association between narcissism and suicidal risk. Methods We focused on the association between narcissism (NPD, narcissistic traits) and suicide (Suicidal Ideation (SI), Non-suicidal Self-Injury (NSSI), Deliberate Self-Harm (DSH), Suicide Attempt (SA) and Suicide (S)). Studies were identified through a PubMed-based search. Reference lists were examined to extract additional articles. This review was performed according to PRISMA Statement. Results We included 33 studies. Most studies evaluated narcissism through DSM, showing heterogeneous results. NPD was associated with low impulsivity and high planning, but also with a higher number of SAs. Studies evaluating narcissism as a trait were more coherent. SI, NSSI and DSH showed an association with vulnerable narcissism. These associations were explained by mediation and moderation models including shame and dissociation. The grandiose component was associated with severe repetitive NSSIs and S in high suicidal risk samples. Impulsivity showed no effect. Conclusions It is possible to develop hypothesis, even if not causal relationships, on the association between narcissism and suicidal risk. Grandiose narcissism seemed to be protective for suicidal outcomes with low intent to die, while vulnerable narcissism seemed to be associated. However grandiose narcissism seemed to be a risk factor for suicidal outcomes with high intent to die, showing low impulsivity and high planning and severity. New studies, differentiating between narcissistic components, are needed.
The assessment of the association between narcissism and suicidal risk is crucial.
Limitations: Only PubMed database; lack of longitudinal studies; most of studies (k = 24,70.6%)
used the DSM definition of narcissism.
This review was performed according to the
PRISMA statement.
Search strategy and selection criteria
We conducted a systematic search of PubMed
database until January 2020.
Studies were included if:they were published
in a peer-reviewed journal; they were written in
English; they were Cohort, Case Control, Cross
Sectional or Case Series with a sample size≥10.
Studies were excluded if:they were Systematic
Reviews or Overviews, Case Reports and Letters
to the Editor.
To provide a systematic overview of studies
investigating the association between
narcissism and suicidal risk we performed the
first systematic review on this topic.
We assessed different aspects of suicidal
thoughts and behaviors [Suicidal Ideation (SI),
Non-suicidal Self-Injury (NSSI), Deliberate Self-
Harm (DSH), Suicide Attempt (SA) and Suicide
(S)] and any definition of narcissism
[Narcissistic Personality Disorder (NPD),
Grandiose Narcissism (GN), Vulnerable
Narcissism (VN)].
ABSTRACT: Introduction: Although suicide showed an association with personality disorders, few studies focused on narcissism. This association is interesting, especially in what authors called a “narcissism epidemic”, considering
narcissistic wounds to which subjects could be subjected. Objectives: To systematically review the association between narcissism and suicidal risk. Methods: We focused on the association between narcissism and suicide (Suicidal
Ideation (SI), Non-suicidal Self-Injury (NSSI), Deliberate Self-Harm (DSH), Suicide Attempt (SA) and Suicide (S)). Studies were identified through a PubMed-based search. Reference lists were examined to extract additional articles.
This review was performed according to PRISMA Statement. Results: We included 34 studies. Most studies evaluated narcissism through DSM, showing heterogeneous results. NPD was associated with low impulsivity and high
planning, but also with a higher number of SAs. Studies evaluating narcissism as a trait were more coherent. SI, NSSI and DSH showed an association with vulnerable narcissism, explained by mediation and moderation models
including shame and dissociation. The grandiose component was associated with severe repetitive NSSIs and S in high suicidal risk samples. Impulsivity showed no effect. Conclusions: It is possible to develop hypothesis, even if not
causal relationships, on the association between narcissism and suicidal risk. Grandiose narcissism seemed to be protective for suicidal outcomes with low intent to die, while vulnerable narcissism seemed to be associated. However
grandiose narcissism seemed to be a risk factor for suicidal outcomes with high intent to die, showing low impulsivity and high planning and severity. New studies, differentiating between narcissistic components, are needed.
Copyright © 2021 Veronica Sprio, Fabio Madeddu, Raffaella Calati
raffaella.calati@unimib.com
v.sprio@campus.unimib.it
CAN NARCISSISM BE CONSIDERED A RISK FACTOR FOR SUICIDAL THOUGHTS AND BEHAVIORS?
A SYSTEMATIC REVIEW OF THE LITERATURE
Veronica Sprio (a), Fabio Madeddu (a), Raffaella Calati, Psy.D., Ph.D. (a, b)
(a) Department of Psychology, University of Milan-Bicocca, Milan, Italy
(b) Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France
The association between narcissism and suicide risk is underestimated in literature. The Narcissistic
Personality Disorder underlines a persistent grandiosity and a lack of empathy [1]. Several authors,
however, stressed the presence of a vulnerable narcissistic pole, characterized by shame and low
self-esteem [2, 3]. The analysis of suicidal risk considering these subcomponents is of crucial
importance.
AIM
RESULTS
Figure 1. PRISMA flow diagram. CONCLUSION
1. American Psychiatric Association (2014). Diagnostic and statistical manual of mental disorders. 5th edition. Wahington.
2. Kohut, H. (1972). Thoughts on narcissism and narcissistic rage. Psychoanalytic Study of the Child, VOL.27, 360400.
3. Madeddu, F. (2020). I mille volti di Narciso. Fragilità e arroganza tra normalità e patologia. Milano: Cortina Raffaello.
METHODS
INTRODUCTION
Table 1. Data
Extraction.
Symbols: +: positive association; −: negative association, LA: lack of association.
Table 2. Results.
... Williams, et al (2021) equally explained that suicidal ideation appears to perform the task of repairing a sense of control and self-worth in narcissistic persons in a condition of emotional dysregulation. Conversely, Sprio, et al (2021) found inverse association between narcissistic grandiosity and suicidal ideation noting that grandiose narcissism looked to be a defensive factor against suicidal outcomes. On the contrary to dissimilarities in result on grandiose narcissism and suicidal ideation, there appeared to be congruence of results on relationship between vulnerable narcissism and suicidal ideation. ...
... It is not also in congruence with the study of Rohmann et al (2019), Williams, et al (2021, andBrailovskaia, (2021) who found the two variables positively associated because grandiose narcissists are likely to result into suicidal ideation when the longing for self-gratification and societal approval are not met to the desired level. The study is however aligned with the study of Sprio, et al (2021) who discovered inverse association between grandiosity and suicidal ideation. ...
Article
Full-text available
The study explored the predictors of suicidal ideation among university undergraduates focusing on the roles of narcissism, substance usage, and self-regulation. A correlational approach was adopted for the study. A total of 1,411 undergraduates selected through a multistage random sampling from three Nigerian universities participated in the study. Suicide Ideation Scale (α= .76), The Short Self-Regulation Questionnaire (α=.87), Drug Abuse Screening Test (α=.7), and Pathological Narcissism Inventory (α=.94) were used to gather information from the participants. Data collected were subjected to statistical screening through the Pearson Product Moment Correlation and multiple regression. The outcomes showed that a combination of the three main predictors explained a total of 32% (R2=.322; F(4,1406)= 166.557; p<.01) of the variance in suicide ideation. Narcissistic Grandiosity (β=-.507; t=-14.945, P<0.01), and Self-regulatory Behaviour (β=-.155; t=-6.411, P<0.01) inversely predicted suicidal ideation while Narcissistic Vulnerability (β= .573; t= 16.864, P<0.01), and Substance Abuse (β= .274; t= 11.453, P<0.01) positively predicted it. The findings underscore the need for comprehensive mental health support systems that address the underlying psychological factors contributing to suicidal ideation.
... Williams, et al (2021) equally explained that suicidal ideation appears to perform the task of repairing a sense of control and self-worth in narcissistic persons in a condition of emotional dysregulation. Conversely, Sprio, et al (2021) found inverse association between narcissistic grandiosity and suicidal ideation noting that grandiose narcissism looked to be a defensive factor against suicidal outcomes. On the contrary to dissimilarities in result on grandiose narcissism and suicidal ideation, there appeared to be congruence of results on relationship between vulnerable narcissism and suicidal ideation. ...
... It is not also in congruence with the study of Rohmann et al (2019), Williams, et al (2021, andBrailovskaia, (2021) who found the two variables positively associated because grandiose narcissists are likely to result into suicidal ideation when the longing for self-gratification and societal approval are not met to the desired level. The study is however aligned with the study of Sprio, et al (2021) who discovered inverse association between grandiosity and suicidal ideation. ...
Article
Full-text available
The study explored the predictors of suicidal ideation among university undergraduates focusing on the roles of narcissism, substance usage, and self-regulation. A correlational approach was adopted for the study. A total of 1,411 undergraduates selected through a multistage random sampling from three Nigerian universities participated in the study. Suicide Ideation Scale (α= .76), The Short Self-Regulation Questionnaire (α=.87), Drug Abuse Screening Test (α=.7), and Pathological Narcissism Inventory (α=.94) were used to gather information from the participants. Data collected were subjected to statistical screening through the Pearson Product Moment Correlation and multiple regression. The outcomes showed that a combination of the three main predictors explained a total of 32% (R2=.322; F(4,1406)= 166.557; p.01) of the variance in suicide ideation. Narcissistic Grandiosity (β= -.507; t= -14.945, P0.01), and Self-regulatory Behaviour (β= -.155; t= -6.411, P0.01) inversely predicted suicidal ideation while Narcissistic Vulnerability (β= .573; t= 16.864, P0.01), and Substance Abuse (β= .274; t= 11.453, P0.01) positively predicted it. The findings underscore the need for comprehensive mental health support systems that address the underlying psychological factors contributing to suicidal ideation.