The DSM-5 defines narcissistic personality disorder as a pervasive pattern of grandiosity in fantasy or behavior, a need for admiration, and a lack of empathy, beginning in early adulthood and present in a variety of contexts, as indicated by five (or more) of the following behavioral patterns:
- Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
- Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
- Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
- Requires excessive admiration.
- Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
- Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
- Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
- Is often envious of others or believes that others are envious of him or her.
- Shows arrogant, haughty behaviors or attitudes.
Clinical narcissists display co-occurring or oscillating states of grandiosity and hypersensitivity. Accordingly, inventories used to determine pathological narcissism, like the Pathological Narcissism Inventory, encompass hypersensitivity/vulnerability measures alongside measures of grandiosity. In the Pathological Narcissism Inventory, grandiosity is measured by the patient’s responses on a 5-point scale to questions like “I often fantasize about being recognized for my accomplishments,” “I often fantasize about being rewarded for my efforts,” and “I want to amount to something in the eyes of the world,” whereas hypersensitivity/vulnerability is assessed by the patient’s responses on a five-point scale to questions like “It’s hard for me to feel good about myself unless I know other people like me,” “It’s hard to show others the weaknesses I feel inside,” and “I like to have friends who rely on me because it makes me feel important.” Because of the co-occurrence or oscillation of grandiosity and hypersensitivity in clinical narcissism, there are no officially recognized subtypes of clinical narcissism.
Clinical narcissism is rare. It only affects about one percent of the population, and this number appears to stay fairly constant. When a flashy headline exclaims that narcissism is on the rise, the term “narcissism” is used to refer to the more prevalent subclinical, or everyday variant of narcissism seen in the general population. Upward of ten percent of people in their twenties are believed to suffer from subclinical narcissism, severe enough to compromise their interpersonal relationships.
There are two subtypes of subclinical narcissism: grandiose narcissism, which is continuous with a narcissistic personality disorder, and vulnerable (or hypersensitive/covert) narcissism. Both subtypes have self-centeredness as a core feature, but the self-absorption is expressed differently in the two cases.
Grandiose narcissism is characterized by extraversion, low neuroticism and overt expressions of feelings of superiority and entitlement. Owing to their grandiosity, they believe that they are somehow above the rest of us, and that they, therefore, are entitled to special treatment. In their view, our job is to cater to their needs. They are true egomaniacs.
Vulnerable narcissism reflects introversive self-absorbedness, high neuroticism, hypersensitivity even to gentle criticism, and a constant need for reassurance. As Dr. Craig Malkin points out in Rethinking Narcissism, vulnerable narcissists “are just as convinced that they’re better than others as any other narcissist, but they fear criticism so viscerally that they shy away from, and even seem panicked by, people and attention” (p. 34).
Owing to the apparent lack of a common core between the subtypes of narcissism, most personality researchers regard grandiose and vulnerable narcissism as independent traits. However, the fact that the two traits are co-present or oscillate in narcissistic personality disorder, the clinical type, suggests that they do in fact have a common basis.
By controlling for differences in extraversion, psychologist Emanuel Jauk and his collaborators were able to show that grandiose and vulnerable narcissists share a common core of narcissistic traits, including contempt-proneness. But the distinct narcissistic styles of the two subtypes are not due merely to differential scores on extraversion. Because of their high neuroticism and hypersensitivity to criticism, vulnerable narcissists prone to overreact emotionally, always on the verge of bursting open with hatred.
Vulnerable narcissism is associated with dissociation of the self-image into an explicit, positive self-image and an implicit, negative self-image. The positive self-image is associated with excessive pride, whereas the negative self-image is associated with shame and humiliation. When receiving only positive feedback, the narcissist is able to keep the negative shame-filled self-image hidden below the level of conscious awareness. But when they experience external feedback as criticism, they are forced to confront their negative self-image and feel deeply ashamed.
Whereas the vulnerable narcissist is struggling with internally conflicting self-images, no hidden negative self-representation is threatening to make a dent in the grandiose narcissist’s positive self-image. Negative feedback, therefore, doesn’t have as profound an impact on the grandiose narcissist. But the deep shame this brings upon the vulnerable narcissist turns her into a combustible compound destined to explode in a frightening outburst of anger or all-consuming fit of hatred. This hostile reaction to insinuations of imperfection is also known as “narcissistic rage.”
Jauk E, Weigle E, Lehmann K, Benedek M, Neubauer A.C. (2017). “The Relationship between Grandiose and Vulnerable (Hypersensitive) Narcissism,” Front Psychol. 8:1600.
Malkin, C. (2015). Rethinking Narcissism: The Secret to Recognizing and Coping with Narcissists. New York: Harper Perennial.