L. Grande, used with permission
Source: L. Grande, used with permission

It is not unusual today for individuals to be labeled as narcissistic by family members, friends, or co-workers. It has become a popular concept and, according to some experts, a more common problem among today’s Generation Y than among prior generations (Twenge, 2006). Other experts disagree about the change in prevalence. Most notably, Dr. Craig Malkin has written comprehensively on the subject of narcissism (Malkin, 2015) and has concluded that the prevalence of Narcissistic Personality Disorder (a specific diagnosable form) remains unchanged at 1% of the population. The contradictions are head-spinning, especially when you take into account all of the various forms of this personality style and all of the labels given to these forms.

It is somewhat helpful to know that most of the experts at least agree that there are different forms of narcissism. The most basic difference is that between what most have called “grandiose narcissism” versus “vulnerable narcissism” (Wink, 1991; Dickinson and Pincus, 2003). The grandiose narcissist is described as arrogant, entitled, exploitative, and envious. He maintains his own self-esteem by self-enhancement, denial of weaknesses and demands of entitlement. He may become angry and aggressive (at least verbally) when his needs are not met. In contrast, the vulnerable narcissist is overly self-inhibited and appears modest, but actually has grandiose expectations for himself and others. The failure to meet his own high expectations as well as the failure of others to meet his expectations often leads to anger, disappointment, shame, and social withdrawal. Both types feel entitled, lack empathy, and exploit others to meet their own needs.

A further distinction is that the grandiose narcissist is more social, more aggressive and tends to be dominant in relationships. He is usually characterized by a high level of self-acceptance, although here is another example of disagreement in the literature. Some have argued that the grandiose narcissist actually has low self-esteem and covers up for those feelings with arrogance. For a discussion of those differing views, see “http://psychologytoday.com/blog/the-narcissism-epidemic/narcissism-and-the-myths-that-just-won-t-die.” There seems to be less controversy about whether or not the vulnerable narcissist has low self-esteem. These individuals exhibit more distress, decreased sociability, and lower levels of self-acceptance. An interesting contrast was noted when the spouses of narcissists were asked to describe the behaviors of concern to them. Grandiose narcissists were described as aggressive, exhibitionistic, and lacking awareness of how their behavior affects others. Vulnerable narcissists were described by spouses as dissatisfied, anxious, and bitter. (Wink, 1991).

Contrary to the standard grandiose vs. vulnerable distinction, Malkin disputes the idea that any narcissist is vulnerable. He prefers the terms “extroverted narcissist” and “introverted narcissist” (Malkin, 2015).  This re-labeling emphasizes that the narcissistic person is less often the victim/vulnerable one than those with whom s/he lives or works. Malkin adds a third sub-type to his description of narcissistic personality styles: the “communal narcissist”. This is the person who promotes himself as committed to the general well-being of others. This is the do-gooder who appears to be invested in helping others but eventually is found out to be acting in his own self-interest and disregarding the negative consequence for others.

It is important to distinguish “healthy narcissism” (http://psychologytoday.com/blog/romance-redux/201602/the-five-most-dangerous-myths-about-narcissisn-part-2) from any type of personality disorder. This is really just an acknowledgement that people who are reasonably confident, happy, and see themselves in a positive light are psychologically healthy. Having positive self-esteem does not make someone narcissistic in the clinical (problematic) sense. The frequent consequence for those who do not sufficiently self-enhance is anxiety or depression.  The distinguishing characteristics between healthy self-enhancement vs. narcissistic self-focus is that the latter includes an excessive  sense of entitlement and the belief that it is acceptable to exploit others in order to meet one’s own needs.

When self-love is combined with feeling entitled, willingness to exploit others, and low levels of empathy to the point that functioning is impaired, Narcisisstic Personality Disorder (NPD) exists. This is an official clinical diagnosis used to identify someone so high in the traits of narcissism that their behavior interferes with their ability to function. NPD was first described by Heinz Kohut, founder of Self Psychology, in 1979. It remains as part of the current classification system of the 10 personality disorders. However, even though this form of narcissism has a defined set of traits, it is not always clear as to how to define “impaired functioning”. A person might achieve something as significant as becoming  a leader of a company, or even the President of the United States, and yet not be functioning effectively in that role.

More than a decade before Kohut described NPD, social psychologist Erich Fromm coined the term “malignant narcissist” (Fromm, 1964). His chilling description reported that this form of narcissism was “the most severe pathology and the root of the most vicious destructiveness and inhumanity.” Today, that description is reserved for the Antisocial Personality Disorder. In fact, the two personality styles are closely related. Along the spectrum from “narcissistic traits” to NPD to “malignant narcissist” to sociopath, the level of paranoia, anger, and aggression increases (http://psychologytoday.com/blog/evil-deeds/201707/is-it-narcissism-or-sociopathy). The capacity for attachment, commitment, and empathy decreases. While the person with narcissistic traits will show a low level of empathy, the sociopath will exhibit a complete lack of empathy. The narcissist can identify with powerful people and admire them. The sociopath does not identify with anyone nor does he admire anyone. He does not care what others think of him, unlike the narcissist who craves attention and admiration.

created by Dianne Grande
Degrees of Narcissism 
Source: created by Dianne Grande

At this point, you may be asking, “Why do we care about all of these labels and subtypes?” As a therapist, the distinction in types suggests important differences in both the motivation and the ability to change behavior. The more distressed, anxious vulnerable (aka “introverted”) narcissist is probably more motivated to seek help and adjust behavior in order to relieve emotional pain. Repeated relationship failures or job losses (due to inability to work with others) may lead to a willingness to seek help. Since the grandiose narcissist is more effective at self-enhancement and denial of weaknesses, s/he is less likely to admit the need for personal growth. Acknowledgement of any weakness is inconsistent with the persona of grandiosity. Both types are unlikely to take responsibility for their own difficulties, nor do they commit to better understanding themselves. However, the introverted (aka 'vulnerable') narcissist might be motivated to seek out therapy for themselves because they are more prone to anxiety and depression. Therapy may be seen as last resort after a history of unsatisfying relationships, even if initially it is just perceived as a place to vent. It may be viewed as simply a way to relieve symptoms of anxiety or depression.

An important point on which most experts agree is that the narcissistic person will not change for you, or because of anything that you do differently. He or she will only change if it serves his or her purpose. As a therapist, I believe in the capacity of any person who desires personal change to accomplish that goal, even if their style has been identified as NPD. As long as the intent to change behavior comes from within (vs. from any other well-intentioned person), it is possible to modify narcissistic behavior.


Dickenson, K., and Pincus, A. (2003). Interpersonal analysis of grandiose and vulnerable narcissism. Journal of Personality Disorders, 17 (3). 188-207. The Guilford Press.

Fromm, E. (1964). The Heart of Man: Its Genius for Good and Evil.  New York, NY: Harper & Row.

Malkin, C. (2015). Rethinking Narcissism: The Bad - And surprising Good- About Feeling Special. UK: Harperwave and Harper.

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