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Contents

Introduction

List of Contributors

Section I: Narcissism and NPD: Constructs and Models

Chapter 1: A Historical Review of Narcissism and Narcissistic Personality

Term and Derivation

Narcissism as a Personality or Character Style and Disorder

The Rise of Interest in Narcissism

The Diagnostic and Statistical Manual and Narcissistic Personality Disorder

Subtypes

Contributions from Social-Personality Psychology

Summary and Conclusion

Chapter 2: Narcissism in the DSM

Dsm-III: NPD Introduced

DSM-III-R

DSM-IV

DSM-5: Looking to the Future

Conclusion

Chapter 3: Narcissism in Official Psychiatric Classification Systems

Narcissistic Personality Disorder in the Diagnostic and Statistical Manual of Mental Disorders

Narcissism as a Dimensional Construct

Overcoming Potential Hurdles in a Dimensional DSM-5 Conceptualization of NPD

Summary

Chapter 4: Narcissistic Grandiosity and Narcissistic Vulnerability

Phenotypic Description of Narcissistic Dysfunction

Narcissistic Grandiosity and Narcissistic Vulnerability

DSM

Assessment of Narcissistic Grandiosity and Narcissistic Vulnerability

Recommendations

Chapter 5: Psychoanalytic Theories on Narcissism and Narcissistic Personality

Introduction

Freud and the Drive Theory

Primary Narcissism

Aggression, Destructive Narcissism, and the Death Drive

Self-Esteem Regulation, Ego-Ideal, and Self-Criticism

Narcissistic Brittleness, Injury, and Trauma

From Drive Toward Structural- and Self-Theories

Narcissistic Personality Disorder

The Ego-Psychological and Object-Relation Theory

The Self-Psychological Theory

The Interpersonal Relational School and Intersubjectivity

Conclusion and Implications for Treatment

Chapter 6: Narcissism from the Perspective of the Dynamic Self-Regulatory Processing Model

The Dynamic Self-Regulatory Processing Model

The Distinctive Narcissistic Signature: Evidence Corresponding to the Model

Taking Stock: Heuristic Utility of the Self-Regulatory Model and Future Directions

Conclusions

Chapter 7: Trait Personality Models of Narcissistic Personality Disorder, Grandiose Narcissism, and Vulnerable Narcissism

Method and Results

Discussion

Chapter 8: Narcissism, the Agency Model, and Approach-Avoidance Motivation

Agency Model of Narcissism

Approach-Avoidance Motivation

Why Should Narcissists be Approach-Oriented?

Are Narcissists Approach-Oriented?

Approach Versus Avoidance Motivation: Is One More Important than the Other?

A Specific Application: Narcissism and Financial Decision Making

Conclusion

Chapter 9: Behind the Mask

The Psychodynamic Mask Model of Narcissism

Do Narcissists Possess Low Implicit Self-Esteem?

Fragile High Self-Esteem

The Inconsistent Association Between Narcissism and Implicit Self-Esteem

Conclusion

Section II: Assessment of Narcissism and NPD

Chapter 10: Assessment of Narcissistic Personality Disorder

Dimensional Versus Categorical Assessment of PDS

Structured and Semi-Structured Interviews for PD Assessment

Self-Report Measures for PD Assessment

Conclusions and Future Directions

Chapter 11: The Measurement of Trait Narcissism in Social-Personality Research

A Review of Narcissism Measures in Social-Personality Research

Summary

Chapter 12: Of Tails and their Dogs

The Tail-Wagging-the-Dog Critique of Narcissism Scales

An Illustrative Empirical Example

Chapter 13: Addressing Criticisms of the Narcissistic Personality Inventory (NPI)

Questions of Validity

Conclusions

Chapter 14: Assessment of Youth Narcissism

The Promise and Peril of Assessing Youth Narcissism

Assessment Approaches

Developmental Issues

Conclusions and Future Directions

Section III: Epidemiology and Etiology of Narcissism and NPD

Chapter 15: Sociodemographic Correlates of DSM-IV Narcissistic Personality Disorder

Methods

Statistical Analysis

Results

Conclusions

Chapter 16: Parenting as a Cause of Narcissism

Clinical Theories on Parenting and Narcissism

Putting Clinical Theory to Empirical Test

Future Directions

Conclusion

Chapter 17: Examining “Developmental Me”

The Life Span Trajectory of Narcissism

Narcissism Research During Childhood

Narcissism Research During Adolescence and Emerging Adulthood

Narcissism Research During Adulthood

Connections to Social Investment Theory

Chapter 18: Narcissism and Culture

Cultural Products and Narcissism

Regional/National Culture and Narcissism

Generational Differences in Narcissism

Conclusions

Chapter 19: The Intertwined Evolution of Narcissism and Short-Term Mating

Empirical Evidence Consistent with Our Hypothesis

The Narcissism Literature from Our Evolutionary Perspective

Predictions and Future Directions

Summary and Conclusions

Chapter 20: Neurophysiological Correlates of Narcissism and Psychopathy

Neuroscientific Investigations of Narcissism

Neurocognitive Correlates of Related Personality and Motivational Constructs

Extraversion

Neuroscientific and Physiological Examinations of Psychopathy

Future Directions for Physiological Studies of Narcissism

Conclusion

Section IV: Comorbidity and Correlates

Chapter 21: Comorbidity between Narcissistic Personality Disorder and Axis I Diagnoses

Narcissistic Personality Disorder in Schizophrenia

Narcissistic Personality Disorder in Bipolar and Major Depression and Dysthymia

Narcissistic Personality Disorder and Anxiety Disorders

Narcissistic Personality Disorder and Eating Disorders

Narcissistic Personality Disorder and Alcohol and Substance Use Disorders (SUD)

The Concept of Narcissism and its Place in Psychopathology

Summary of the Comorbidity between Narcissistic Personality Disorder and Axis I Disorders

Recommendations and Future Research

Chapter 22: The Comorbidity of Narcissistic Personality Disorder with Other DSM-IV Personality Disorders

Comorbidity of NPD with other Personality Disorders

Histrionic Personality Disorder

Antisocial Personality Disorder

Categorically Distinct?

NPD Diagnostic Co-Occurrence from the Perspective of the FFM

Conclusions

Chapter 23: “I Love Me Some Me”

Defining Our Terms

Examining the Links

Summary and Concluding Remarks

Chapter 24: Psychopathy and Narcissism

Theoretical Overlap between Psychopathy and Narcissism

Empirical Overlap between Psychopathy and Narcissism

Psychopathy and Narcissism through the Lens of the FFM

Conclusions

Section V: Intra- and Interpersonal Processes

Chapter 25: Getting to Know a Narcissist Inside and Out

Self-Perceptions: How Do Narcissists See Themselves?

Others’ Perceptions: How are Narcissists Seen by Others?

Meta-Perceptions: What Kind of Impression Do Narcissists think they Make?

Summary

Method

Results

Discussion

Chapter 26: Self-Other Discrepancies

NPD Viewed by Peers and Strangers

Discrepancies Among Self, Informants, and Interviewers

Npd and Social Impairment

Conclusions

Chapter 27: Narcissistic Self-Enhancement

Symptoms of Narcissistic Self-Enhancement

Competing Explanations for Narcissistic Self-Enhancement

Do Narcissists Undermine their Self-Enhancement Goals?

Concluding Thoughts

Chapter 28: When the Narcissistic Ego Deflates, Narcissistic Aggression Inflates

Historical Psychological Perspectives

Does Low Self-Esteem Predict Aggression?

Does Narcissism Predict Aggression?

Controversies

Future Research

Conclusion

Chapter 29: The Emotional Dynamics of Narcissism

An Emotion-Centered Model of Narcissism

Benefits of an Emotion-Centered Approach to Narcissism

Implications for Assessment

Conclusion

Chapter 30: Narcissism and Romantic Relationships

Agency Model

Contextual Reinforcement Model

Chocolate Cake Model

Can Narcissists Change?

Conclusion: Revisiting the Paradox

Chapter 31: Narcissism and Sexuality

Relationship between Narcissism and Specific Sexual Attitudes, Behaviors, and Outcomes

Theoretical and Empirical Inconsistencies

The Necessity of Domain-Specific Measurements of Narcissism

Directions for Future Research

Conclusion

Chapter 32: Narcissism and Social Networks

Social Network Analysis

Narcissism in Sociocentric Networks

Narcissism in Egocentric Networks

Narcissism and Online Social Networks

Conclusions

Chapter 33: Narcissism and the World Wide Web

Key Differences between the World Wide Web and the “Real World”

How Narcissists Use the Web

Review of Research on Narcissism and the World Wide Web

Call for Research and Narcissism on the World Wide Web

Conclusion

Chapter 34: Narcissism and Brand Name Consumerism

Consumer Behavior

Narcissistic Self-Enhancement

Narcissistic Materialism

Narcissistic Preference for Brand Names

Need for Additional Empirical Support for Narcissistic Brand-Name Preferences

Why Do Narcissists Prefer Brand Names? Distal Etiology

Empirical Validation of Inner Fragility Driving Narcissistic Brand-Name Preferences: Can Narcissists be “Rehabilitated”?

Does the Pursuit of Brand Names Bring about Happiness in Narcissists?

Concluding Remarks

Chapter 35: Leadership

Introduction

Narcissism as a Component of Personality

The Assessment of Narcissism

Narcissism and Leadership

Chapter 36: Celebrity and Narcissism

The Appeal of Celebrity to Narcissists

Why Narcissists Succeed in the Entertainment Industry

Celebrity as a Route to Narcissism

The Consequences of Being a Narcissistic Celebrity

Conclusion: From Celebrity to Culture

Chapter 37: Narcissism and Spirituality

Narcissism, Spirituality, and Religion

Narcissism and Self-Compassion

Narcissism and Humility

Implications for Clinical Practice

Conclusion

Section VI: Treatment

Chapter 38: Psychodynamic Psychotherapy for Narcissistic Personality

Levels of Narcissism

Elements of Technique

Summary

Chapter 39: Attachment Theory and Narcissistic Personality Disorder

Two Attachment Subtypes of Narcissism?

Attachment Experiences Associated with Narcissism: Overindulgence or Rejection?

Narcissistic Attachment Representations: Avoidant and/or Anxious?

Treatment Implications

Chapter 40: Schema Therapy for Narcissism

Early Maladaptive Schemas

Schema Modes

Core Developmental Domains

Applying Schema Therapy to Narcissistic Personality Disorder (NPD)

Schemas of Patients with NPD

A Conceptualization of NPD in Schema Terms

Schema Modes of Patients with NPD

Goals and Strategies for Treatment: Barriers, Leverage, Self-Disclosure, Limit-Setting, and Empathic Confrontation

A Case Study

Concluding Remarks

Chapter 41: Cognitive Behavioral Approaches to the Treatment of Narcissistic Personality Disorder

Cognitive Behavior Therapy Approaches and Outcomes

Obstacles to Treatment of Narcissistic Personality Disorder

The Need for Randomized Clinical Trials is Clear

Case Example of Situational Analysis for a Patient with Narcissistic Personality Disorder

Conclusions

Chapter 42: Treatment of Narcissistic Personality Disorder Symptoms in a Dialectical Behavior Therapy Framework

Why Dialectical Behavior Therapy?

Dialectical Behavior Therapy

Collaboration and Nonjudgmentalness

Functional Analysis/Outcome Data

Therapist Burnout

Client Demographics and History

Presenting Symptoms and Treatment Goals

Treatment Goals and Structure

NPD Targets

Summary and discussion

Response to Treatment

Chapter 43: Treating Narcissus

Past Research on Reducing the Manifestations of Narcissism

Future Research on Reducing the Manifestations of Narcissism

Promising New Directions in Research

Conclusion

Conclusion: Narcissism and Narcissistic Personality Disorder

About the Editors

Author Index

Subject Index

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To our families

Introduction

W. Keith Campbell and Joshua D. Miller

Interest in the topic of narcissism and its clinical variant, narcissistic personality disorder (NPD), has grown dramatically in recent years. Research on this topic was traditionally found in the fields of social-personality psychology (trait narcissism) and clinical psychology and psychiatry (NPD). More recently, however, work on narcissism has made its way into industrial-organizational (I-O) psychology, developmental psychology, decision making, organizational behavior, criminology, educational research, and political science. Narcissism is examined as a variable of interest in research on many cutting-edge topics, such as behavior on the World Wide Web, corporate leadership, ethics and criminality, and celebrity. Somewhat ironically, narcissism is “hot.”

Unfortunately, this interest in narcissism is hampered by several historical divides. There is the divide between research on trait narcissism versus the categorically conceived of diagnosis of NPD. This split often divides the theory-rich clinical approaches from the data-rich empirical approaches found in social-personality psychology. This divide pervades all aspects of the study of narcissism, including the basic conceptualization of the construct with clinically oriented theorists emphasizing narcissistic vulnerability and social-personality researchers emphasizing narcissistic grandiosity. Indeed, several of the chapters in this handbook present data suggesting that vulnerability and grandiosity may represent two distinct forms or states of narcissism. Given these divides, there are many bridges that need to be built between fields, researchers, and practitioners.

Our goal in organizing The Handbook of Narcissism and Narcissistic Personality Disorder was to bridge these divides by bringing together in one place a diverse and accomplished group of narcissism researchers and practitioners. The Handbook is integrative in that it covers both trait narcissism and NPD. Likewise, it includes contributors from across the spectrum of psychology (clinical, social-personality, I-O, and developmental) and related fields. We have contributions from researchers from a range of theoretical perspectives as well—for example, you will find chapters on psychodynamic (Ronningstam, Chapter 5), social-psychological (Morf and colleagues, Chapter 6) and trait models (Miller and Maples, Chapter 7) of narcissism side-by-side. Likewise, the treatments discussed in the Handbook range from psychodynamic (Diamond and colleagues, Chapter 38), cognitive-behavioral (Cukrowicz and colleagues, Chapter 41) and even experimental interventions (Thomaes and Bushman, Chapter 43). In short, thanks to the work of a group of talented contributors, we have a truly integrative Handbook that should benefit readers from a wide array of perspectives.

The Handbook itself is organized into six sections. Section I focuses on the constructs of narcissism and NPD. We start with a historical overview of both constructs by Levy and colleagues (Chapter 1). This is followed by two chapters on NPD and the Diagnostic and Statistical Manual of Mental Disorders (DSM). The first by Reynolds and Lejuez (Chapter 2) takes a historical view; whereas the second by South and colleagues (Chapter 3) focuses on NPD and its possible representation in the DSM-5. The next chapter by Pincus and Roche (Chapter 4) examines one of the major divides in narcissism: the distinction between grandiose and vulnerable narcissism. We then have the three chapters mentioned earlier—psychodynamic, social psychological, and trait approaches to narcissism/NPD. Section I ends with two more useful models: the agency model (Foster and Brennan, Chapter 8) and the mask model (Zeigler-Hill and Jordan, Chapter 9).

Section II focuses on issues of assessment for both narcissism and NPD. It begins with an overview of assessment measures for NPD (Watson and Bagby, Chapter 10) and trait narcissism (Tamborski and Brown, Chapter 11). Given the ongoing debate regarding the most commonly used measure of trait narcissism, the Narcissistic Personality Inventory (NPI), we have two chapters taking different sides so that readers get a full understanding of the issues involved (Chapters 12 and 13). The section ends with an important review of the assessment of narcissism in youth (Barry and Ansel, Chapter 14).

Section III focuses on the epidemiology and etiology of narcissism. Pulay and colleagues (Chapter 15) provide a detailed description of their large national epidemiological survey of NPD. This is followed by three perspectives on the etiology of narcissism: parenting (Horton, Chapter 16); development (Hill and Roberts, Chapter 17); and culture (Twenge, Chapter 18). This is followed by a new evolutionary model of narcissism (Holtzman and Strube, Chapter 19), and the section ends with a chapter on the neurological and physiological processes associated with narcissism (Krusemark, Chapter 20).

Section IV includes chapters that discuss the issue of comorbidity and correlates of narcissism/NPD. S. Simonsen and E. Simonsen (Chapter 21) report on the comorbidity of NPD with Axis I disorders, whereas Widiger (Chapter 22) reviews the comorbidity between NPD and other DSM-IV personality disorders. Next, Bosson and Weaver (Chapter 23) look at the complex relations between narcissism and self-esteem. Finally, Lynam reviews the relations between narcissism/NPD and psychopathy (Chapter 24).

Section V contains a range of chapters that describe the intra- and interpersonal processes associated with narcissism. These include social perception (Carlson and colleagues, Chapter 25), self-other discrepancies (Oltmanns and Lawton, Chapter 26), and self-enhancement (Wallace, Chapter 27). There are also chapters on the relations between narcissism and NPD and important social outcomes like aggression (Bushman and Thomaes, Chapter 28), shame (Tracy and colleagues, Chapter 29), romantic relationships (Brunell and Campbell, Chapter 30), and sexuality (Widman and McNulty, Chapter 31). These are followed by a pair of chapters on the manifestation of narcissism/NPD in social network analyses and social networks (Clifton and Buffardi, respectively, Chapters 32 and 33). The section ends with four more topical chapters on narcissism/NPD and: consumerism (Sedikides and colleagues, Chapter 34), leadership (Hogan and Fico, Chapter 35), celebrity (Gentile, Chapter 36), and spirituality (Sandage and Moe, Chapter 37).

The Handbook ends with a section on the treatment of narcissism/NPD. Each chapter represents the work of an expert in a particular approach: transference-focused psychotherapy (Diamond and colleagues, Chapter 38), attachment therapy (Meyer and Pilkonis, Chapter 39), schema therapy (Behary and Dieckmann, Chapter 40), cognitive behavioral therapy (Cukrowicz and colleagues, Chapter 41) and dialectical behavior therapy (Reed-Knight and Fischer, Chapter 42). Finally, we end with a review of experimental/laboratory manipulations from basic research paradigms that temporarily modify narcissistic behavior and may have promise for translational research (Thomaes and Bushman, Chapter 43).

We would like to end by giving our thanks to the many people who helped to make the Handbook a reality. First, we are grateful to all of the researchers and practitioners who contributed chapters. We were amazed that such a talented (and very, very busy) group would take the time to produce such terrific work for the book. Second, we would like to thank our editor, Patricia “Tisha” Rossi, at John Wiley & Sons. She immediately saw the need for a handbook on narcissism and NPD and has been 100% committed to making this project a success. Finally, we would both like to thank our families for their support throughout this process. Without their support none of this would have been possible.

List of Contributors

Lisa L. Ansel

Department of Psychology

University of Southern Mississippi

R. Michael Bagby

Department of Psychiatry and Psychology

University of Toronto

Christopher T. Barry

Department of Psychology

University of Southern Mississippi

Wendy T. Behary

Director, The Cognitive Therapy Center of New Jersey and The New Jersey Institute for Schema Therapy

President, The International Society of Schema Therapy (ISST)

Jennifer K. Bosson

Department of Psychology

The University of South Florida

James C. Brennan

Department of Psychology

University of South Alabama

Ryan P. Brown

Department of Psychology

University of Oklahoma

Amy B. Brunell

Department of Psychology

Ohio State University at Newark

Laura E. Buffardi

iScience Group

Universidad de Deusto in Bilbao

Brad J. Bushman

School of Communication

The Ohio State University; VU University Amsterdam

Erika N. Carlson

Department of Psychology

University of Washington

Joey T. Cheng

Department of Psychology

University of British Columbia

Sylwia Cisek

Center for Research on Self and Identity, School of Psychology University of Southampton

Allan Clifton

Department of Psychology

Vassar College

Kelly C. Cukrowicz

Department of Psychology

Texas Tech University

Diana Diamond

City University of New York, New York Presbyterian Hospital, Weill Medical College at Cornell University

Eva Dieckmann

Universitätsklinikum Freiburg, Abteilung für Psychiatrie und Psychotherapie

Nicholas Eaton

Department of Psychology

University of Minnesota

William D. Ellison

Department of Psychology

Pennsylvania State University

James Fico

Hogan Assessment Systems

Sarah Fischer

Department of Psychology

University of Georgia

Joshua D. Foster

Department of Psychology

University of South Alabama

Brittany Gentile

Department of Psychology

University of Georgia

Risë B. Goldstein

National Institutes of Health

Bridget F. Grant

National Institutes of Health

Claire M. Hart

Department of Psychology

University of Southampton

Patrick L. Hill

Department of Psychology

University of Illinois at Urbana-Champaign

Robert Hogan

Hogan Assessment Systems

Nicholas S. Holtzman

Department of Psychology

Washington University

Robert S. Horton

Department of Psychology

Wabash College

Thomas E. Joiner

Department of Psychology

Florida State University

Christian H. Jordan

Department of Psychology

Wilfrid Laurier University

Robert Krueger

Department of Psychology

University of Minnesota

Elizabeth A. Krusemark

Department of Psychology

University of Wisconsin-Madison

Erin M. Lawton

Department of Psychology

University of Washington

Carl W. Lejuez

Center for Addictions, Personality, and Emotion Research

University of Maryland, College Park

Kenneth N. Levy

Department of Psychology

Pennsylvania State University

Donald Lynam

Department of Psychological Science

Purdue University

Jessica Maples

Department of Psychology

University of Georgia

Jason P. Martens

Department of Psychology

University of British Columbia

James K. McNulty

Department of Psychology

University of Tennessee, Knoxville

Björn Meyer

Department of Psychosomatic Medicine and Psychotherapy

University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg Eilbek

Shane P. Moe

Department of Marriage and Family Studies

Bethel University

Carolyn C. Morf

Institute of Psychology

University of Bern, Switzerland

Laura Naumann

Department of Psychology

Sonoma State University

Thomas F. Oltmanns

Department of Psychology

University of Washington

Paul A. Pilkonis

Department of Psychiatry

University of Pittsburgh School of Medicine

Aaron L. Pincus

Department of Psychology

Pennsylvania State University

Erin K. Poindexter

Department of Psychology

Florida State University

Attila J. Pulay

National Institutes of Health

Bonney Reed-Knight

Department of Psychology

University of Georgia

Elizabeth K. Reynolds

Center for Addictions, Personality, and Emotion Research

University of Maryland, College Park

Joseph S. Reynoso

Rosemary Furman Counseling Center

Barnard College

Brent W. Roberts

Department of Psychology

University of Illinois at Urbana-Champaign

Richard W. Robins

Department of Psychology

University of California, Davis

Michael J. Roche

Department of Psychology

Pennsylvania State University

Elsa Ronningstam

McLean Hospital

Harvard Medical School

Steven J. Sandage

Department of Marriage and Family Studies

Bethel University

Eva Schürch

Institute of Psychology

University of Bern, Switzerland

Constantine Sedikides

Center for Research on Self and Identity, School of Psychology

University of Southampton

Erik Simonsen

Zealand Region, Psychiatric Research Unit

Sebastian Simonsen

Zealand Region, Psychiatric Research Unit

Susan South

Department of Psychological Sciences

Purdue University

Michael J. Strube

Department of Psychology

Washington University

Michael Tamborski

Department of Psychology

University of Oklahoma

Sander Thomaes

Department of Psychology

Utrecht University

Loredana Torchetti

Institute of Psychology

University of Bern, Switzerland

Jessica L. Tracy

Department of Psychology

University of British Columbia

Jean M. Twenge

Department of Psychology

San Diego State University

Simine Vazire

Department of Psychology

Washington University

Harry M. Wallace

Department of Psychology

Trinity University

Chris Watson

Clinical Research Department

Centre for Addiction and Mental Health

Jonathan R. Weaver

Department of Psychology

The University of South Florida

Thomas A. Widiger

Department of Psychology

University of Kentucky

Laura Widman

Department of Psychology

University of North Carolina, Chapel Hill

Frank Yeomans

New York Presbyterian Hospital, Weill Medical College at Cornell University

Virgil Zeigler-Hill

Department of Psychology

University of Southern Mississippi

SECTION I

NARCISSISM AND NPD: CONSTRUCTS AND MODELS