23 Jul Five Narcissistic Personality Types: Implications for Mental Health Experts
Psychologists must be diligent in their approach when treating individuals diagnosed with narcissism. Differential diagnosis is a crucial tool that can help ensure accurate diagnosis and effective treatment. Narcissistic personality disorder (NPD) is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) as constituting a pervasive pattern of grandiosity (in fantasy or behavior), a constant need for admiration, and a lack of empathy.
Further, the DSM-5 highlights that many successful individuals possess personality traits that meet these criteria of narcissism. However, they constitute narcissistic personality disorder when these traits are inflexible, maladaptive, persistent, and result in significant functional impairment or subjective distress. There is only one diagnostic definition for narcissistic personality disorder; however, psychologists will often encounter individuals in treatment with narcissistic personality traits. Narcissism can be defined by grandiose, vulnerable, antagonistic, communal, or malignant characteristics.
Grandiose narcissism traits are those most people associate with the term “narcissist.” Individuals with these traits tend to overestimate their abilities and intelligence. They are described as outgoing, entitled, and arrogant, have an exaggerated sense of self, and require significant praise and admiration. In relationships, they tend to be competitive and exploitative and lack empathy.
Vulnerable narcissistic personality traits differ significantly from grandiose traits. While these individuals tend to be egocentric, vulnerable narcissists tend to feel victimized. They display low self-esteem, introversion, poor self-confidence, and a higher likelihood of experiencing anxiety, depression, and shame. In interpersonal interactions, they tend to be avoidant and defensive.
Antagonistic narcissist traits are similar to those displayed by individuals with grandiose features. These include arrogance, a focus on rivalry, competitiveness, a tendency to take advantage of others, disagreeableness, and being prone to arguing. A 2020 study reporting in the Journal for Research in Personality examined the implicit self-concept of narcissism. The study concluded that antagonistic narcissism is a subtype of grandiose narcissism, utilizing a proposed antagonistic narcissism Implicit Association Test (AN-IAT) to measure narcissism, aggression, and lack of empathy.
Communal narcissism is the opposite of antagonistic narcissism and also a subtype of grandiose narcissism. Individuals with communal traits tend to require social power with a sense of self-importance. They tend to value fairness and describe themselves as altruistic and generous. They become outraged at moral injustices. Despite these traits, the behavior of individuals with communal narcissism does not align with their beliefs. Research in the 2012 Journal of Personality and Social Psychology found grandiose and communal narcissists shared the same self-motivation while differing in their means of gaining fulfillment. Those with overt tendencies on agentic means, while those with communal traits on communal standards. Communal narcissists hold the same global self-evaluations as grandiose narcissists, such as self-importance, a sense of entitlement, and power over others. This sense of self, however, is based on excessively inflated views of their morality and prosociality.
Malignant narcissism is characterized by traits on the more severe end of the narcissistic spectrum. Like individuals with grandiose traits, an individual with malignant narcissism has an exaggerated sense of self-importance and a need for attention. These personality features are more related to antisocial personality disorder, with a tendency toward vindictiveness, aggression in interactions with others, sadism, and increased paranoia. People with these features are more likely to have involvement with the legal system. A study in 2019 in the Biomedical Journal of Scientific & Technical Research found that narcissism is associated with higher rates of substance use disorders, particularly those with malignant traits.
Differential diagnosis in working with people with narcissistic personality traits can help inform the course of treatment for mental health experts working with people seeking treatment for interpersonal stressors. Narcissism is a complex set of personality traits that can mimic other mental health disorders, such as antisocial and borderline personality disorders, as well as depression and anxiety. Individuals seeking treatment may not be aware of the egocentric roots of the emotional distress that prompts them to treatment. Understanding and identifying the difference in narcissistic personalities can support better treatment outcomes.