The Surprising Consequences of How Narcissists Process Pain

New research looks at pain in narcissism and underlying contributory traits.

Posted Jun 07, 2020

Narcissism is ever a hot topic. We deal with the challenges of pathological narcissism in personal relationships, family, friendships, work, and in our leaders. Narcissism is part of what makes our species great—and could ultimately lead to our downfall if we don't adapt to self-inflicted evolutionary challenges.

Pathological narcissism comes in grandiose and vulnerable sub-types. Grandiose narcissists appear less affected and more authentic. Vulnerable narcissists carry injury, grounding the concept “traumatic narcissism”. Narcissistic vulnerability is a risk for PSTD (2005) as trauma is taken an an ego threat.

Research (2019) has found that narcissism is associated with post-traumatic growth, suggesting narcissism's potentially role in resilience. As self-efficacy is a key factor in PTSD prevention, this is not surprising.

Grandiose narcissism is associated with the personality trait of extroversion, and vulnerable narcissism with introversion (2017). When controlling for extroversion-introversion, the core is self-perceived superiority.  Grandiose narcissists wear it on the sleeve, whereas vulnerable narcissists harbor secret superiority. At high levels of narcissism, researchers found, grandiosity and vulnerability merge.

Having narcissistic traits is imperative for excellence, as the desire to excel in the eyes of oneself and others drives ambition and accomplishment. When balanced, narcissism is at the nexus of self-interest and altruism.

Is narcissism genetic or acquired—or both? One study (2014) found that grandiose and vulnerable narcissism both have genetic and environmental contributions. Another study (2014) looked at agentic and communal narcissism, finding a similar blend of heritability and environment—including parenting behavior. Agentic narcissists are individualistic “action superheroes”. Communal narcissists are “quaint saints,” saving the world through kindness and community. Likely narcissism has epigenetic elements, passed on via stress-related and other mechanisms.

According to social pain overlap research (2004), physical and social exclusion have overlapping brain circuits. Evolution borrowed (“coapted”) neural circuits for physical pain in order to make sense of social reality. Pain processing is relevant for understanding how narcissism shapes our view of personal and social reality.

Amy Brunell, Melissa Buelow and Zina Trost conducted research (2020) looking at whether narcissistic traits track with: 1) how pain is interpreted (“pain catastrophizing”) and fear of moving the body when pain is present (“kinesiophobia”); 2) how social exclusion affects self-esteem, self-perception, mood and performance on cognitive tasks; and 3) how physical pain is experienced in an experimental setting.

In the first study, 1330 undergraduates completed surveys to determine grandiose versus vulnerable narcissism (Pathological Narcissism Inventory, PNI), exploitativeness (Interpersonal Exploitativeness Scale, IES), grandiosity (Narcissistic Grandiosity Scale, NGS), entitlement (Psychological Entitlement Scale, PES), psychological reactions to pain (Pain Catastrophizing Scale, PCS) and fear of inadvertently provoking pain (Tampa Scale of Kinesiophobia).

Vulnerable narcissism was associated with greater pain catastrophizing and kinesiophobia; grandiose narcissism was not. Exploitativeness and trait grandiosity were associated with catastrophizing. Exploitativeness and entitlement were associated with kinesiophobia.

In the secondary study, a group of 105 participants played Cyberball, a standardized way to induce painful social exclusion. Participants play digital catch with two others they believe are human players but who are really computer opponents. Half are cut out of the game in the middle. As every school kid learns, this hurts. 

Participants completed the same basic measures as study 1 (PNI, IES, NGS, PES). They also measured basic needs around belonging, control, meaningful existence, self-esteem, and mood; three measures of cognitive performance—auditory learning (Rey Auditory Verbal Learning Test, AVLT), visual learning, and memory (Rey Complex Figure Test, CFT), and executive function (Wisconsin Card Sorting Task, WCST). They were asked afterward how much concern they had about performance and how much effort they put into the cognitive tests.

Grandiose narcissism was associated with reduced meaning and lower self-esteem. Grandiose narcissists reported greater belonging, sense of control, and better mood, and performed better. But when excluded they crashed, feeling and performing even worse. 

Vulnerable narcissism correlated with low self-esteem, worse performance, and repetitive errors (perseveration), but better mood. In the excluded group, they reported less control and dips in mood and performance on CFT and WCST. Vulnerable narcissism made it harder to do well unless circumstances were just right.

Participants with higher entitlement made less effort and performed worse—but tried harder when included, suggesting performance partially depends on social belonging. Those with higher grandiosity reported lower self-esteem, improved with inclusion. They performed better on cognitive tasks after a delay.

Grandiose participants took a self-esteem hit, compensating by trying harder. If excluded, they found it harder to make an effort. Exploitativeness was associated with greater concern about performance, and even greater concern and effort after social exclusion.

In the third study, 69 participants were subjected to physical pain via one minute of cold-water arm immersion (cold pressor). They completed the same basic measures, rating rated severity of pain every 10 seconds during and after immersion (McGill Pain Questionnaire, MPQ). Some were also led to believe they might have to do it again, the threat condition. All participants rated positive and negative emotion (Positive and Negative Affect Scale, PANAS).

The degree of reported pain was the same for grandiose and vulnerable narcissism. Exploitativeness was associated with greater pain and negative affect, and entitlement with greater negative affect. 

Under threat of future pain, grandiose narcissism tracked with positive emotion, suggesting self-protective preparation (“keep your chin up”). Likewise, grandiose narcissism predicted negative affect, reduced in the threat condition. Exploitativeness was associated with positive emotion under threat, suggesting that risk presents opportunity. 

While there was no difference between grandiose and vulnerable narcissism in terms of reported pain, narcissistic traits associated with lower reported pain and positive emotion particularly when they expected to have to endure pain a second time.

This supports the observation that grandiose and vulnerable narcissism share a common core, and also highlights the way narcissism can be adaptive when adversity is present—even if pathological under ordinary circumstances.

How to optimize narcissism

Narcissism per se is neither good nor bad. There are pros and cons to carrying a sense of superiority with the inherent costs of envy, insecurity, and exposure in exchange for the benefit of preparedness.

Narcissists may be more vulnerable. Other hand, those higher in select narcissism-associated traits are motivated to rise to challenges. This restores individual self-esteem and serves group needs—as long as the narcissism isn’t so extreme it leads to self-sabotage, pulling down the team.

Many find insight into the nature of their own problems elusive or absent (“anosognosia”), impeding personal growth and damaging relationships. Those who want to smooth off the rough edges to move toward healthier narcissism can take heart.  

Narcissism is only one of the four Dark Tetrad traits, which also include Machiavellianism, everyday sadism and psychopathy, and itself is not inherently associated with the cold intent to use others as non-human objects.

One may recognize that narcissism causes problems, getting stuck on how to move forward because brittle responses to feedback and rigid "primitive" defenses trigger resistance to the idea of needing or having to change.

It can feel like a coercive attack accompanied by a feeling of helplessness at not knowing how to change obvious problems, making it worse and moving one further away from curiosity and the desire to move toward better relationship with oneself and others.

Identifying adaptive aspects of narcissism, cultivating compassion for oneself and others, gleaning insight into areas of vulnerability when it comes to performance attitudes, mood, and self-esteem, understanding how one responds to social exclusion and physical pain, and homing in on specific issues such as exploitativeness, entitlement and grandiosity provide perspectives for insight and development.


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