Source: Burlingham/Shutterstock

Pathological narcissism is a personality attribute that characterizes individuals just below the level of a diagnosable disorder, but remains clinically significant. According to the epidemiological data summarized in psychiatry’s diagnostic manual (American Psychiatric Association, 2013), men are more likely to have the personality disorder that forms the clinically significant form of narcissism. Individuals with pathological narcissism also show high levels of distress, as well as engaging in high-risk behaviors that interfere with their ability to lead fulfilling lives.

If there’s a narcissist in your life, you may not feel particularly sympathetic toward his plight. However, as noted by University of British Columbia’s David Kealy and colleagues (2017), the pathologically narcissistic man experiences significant distress and impairment, including interpersonal problems, a tendency toward chronic feelings of depression, and suicidality. In the words of the authors, “Where a stable but dynamic view of the self — including realistic positive appraisals — is a normal component of identity, pathological narcissism is defined by unstable and/or maladaptive regulation of self-image” (p. 156). These men can alternate between grandiose needs to draw attention to themselves in the process of seeking admiration, and extreme vulnerability, in which they experience extreme sadness and low self-esteem.

In addition to the mental health consequences of pathological narcissism, men with these qualities engage in dangerous self-destructive behaviors, including risky sexual behavior, reckless driving, and excessive drug and alcohol use. Their tendency to take risks, along with substance use, reflect a desire to get attention, but also to overcome feelings of shame and emptiness. The aggressiveness they can also show stems from feeling that their self-esteem is threatened, as stated by Kealy et al: “Externally directed rage is thus thought to temporarily relieve the painful effects associated with a weakened self-representation and restore a sense of potency” (p. 157). The authors sought to document, in a nationally representative sample, the extent to which pathological narcissism exists among men. Additionally, because much of the available literature is based on young adult samples (i.e., college students), their investigation included age as a possible factor altering the experience of distress and maladaptive behaviors among pathologically narcissistic men.

Using what’s known as the “Super-Brief Pathological Narcissism Inventory” (SB-PNI), the Vancouver team surveyed a national sample of Canadian men who, additionally, reported on their frequency of maladaptive behaviors and general psychological distress. The SB-PNI includes self-report items on “grandiose” narcissism, such as “I often fantasize about performing heroic deeds,” and “I like to have friends who rely on me because it makes me feel important.” Narcissistic “vulnerability” is assessed on the SB-PNI with items such as “It’s hard to feel good about myself unless I know other people admire me.” Men reported on their maladaptive behaviors on a questionnaire asking them about their patterns of drug use, alcohol use, anger/aggression (“I was verbally aggressive to others”), and risk-taking (“I drove dangerously or aggressively”; “I took unnecessary risks”). A measure of anxiety and depression assessed feelings of nervousness, hopelessness, and worthlessness.

The findings underscored the importance of taking age into account when understanding narcissism. Research on personality disorders, in general, shows a lower percentage of individuals in mid and later life who have the so-called “immature” personality disorders that include narcissistic personality disorder. Accordingly, in the Canadian study, the sample as a whole, whose average age was 49 years (with a range from 19 to 86), pathological narcissism scores were lower than those obtained in samples of undergraduates. Within the current sample, younger men also were higher in SB-PNI scores than their older counterparts. In fact, age was negatively correlated with all of the measures of distress and maladaptive behaviors.

As predicted, men with high pathological narcissism scores were more likely to experience distress, to use drugs and alcohol, and to engage in angry and aggressive acts. In the case of drug use, though, age also played a role in that it was only among the younger men that pathological narcissism was correlated with high scores on this maladaptive behavior measure. In the area of risk-taking behavior, there was also a complex relationship with pathological narcissism, in that it was only among men with high levels of distress that high narcissism related to high-risk behavior.

Given the associations with age, pathological narcissism, then, appears to be less of a stable trait than we might assume. As men mature into their middle and later adult years, they potentially gain greater self-confidence, while they also modulate their high risk-taking and substance abuse-related tendencies. Another possibility is that, unlike the Billy Joel song, only the risky die young. Those individuals who engage in heavy patterns of substance abuse and aggression, for example, experience higher accident- or illness-related mortality. However, it is also possible that as they advance through their adult years, those who were narcissistic when younger gain greater perspective, particularly if they manage to achieve a certain level of success in their work and romantic lives.

The authors also suggest that for the pathologically narcissistic male, there is an element of hyper-masculinity that leads them, especially when younger, to try to show just how macho they are by drinking heavily, treating others aggressively, and otherwise trying to overcome underlying feelings of weakness and deficiency. Unfortunately, there were no measures in this study assessing identification with masculine role stereotypes, but it seems reasonable to assume that the pathologically narcissistic may believe they have to overcome their core inferiority by proving just how manly they really are.

In summary, the Kealy et al study suggests that pathological narcissism isn’t a single entity on which an individual is high or low. Over the years of adulthood, men may learn through bad experiences that they need to modulate their aggressiveness and high-risk behavior, or they may gain a greater inner sense of security that allows them to express weakness without feeling flawed. By the same token, as the authors suggest, mental health workers who provide treatment to men with substance abuse or high-risk aggressive behavior may wish to consider the role of narcissism as a contributing factor.

For those individuals who live with or love a man high in pathological narcissism, the study’s findings also provide insight into the deep distress these individuals feel on a day-to-day basis. Although it is no fun to be in a relationship with a man high in narcissism, it is no fun to be that man either.


American Psychiatric Association (2013). Diagnostic and Statistical Manual - 5th Edition: DSM-5. Washington, DC: American Psychiatric Association

Kealy, D., Ogrodniczuk, J. S., Rice, S. M., & Oliffe, J. L. (2017). Pathological narcissism and maladaptive self-regulatory behaviours in a nationally representative sample of Canadian men. Psychiatry Research, 256156-161. doi:10.1016/j.psychres.2017.06.009

You are reading

Fulfillment at Any Age

How Much Is Too Much When It Comes to Self-Disclosure?

A condition called privacy fatigue may lead you to let down your filters

The Best Way to Handle Your Partner’s Silent Treatment

When your partner gives you the silent treatment, what it means and what to do.

Identity in Borderline Personality Disorder: A New Approach

Insights into borderline personality disorder from a new measure of identity