Narcissistic grandiosity and narcissistic vulnerability in psychotherapy.
Abstract
This article briefly summarizes the empirical and clinical literature underlying a contemporary clinical model of pathological narcissism. Unlike the DSM Narcissistic Personality Disorder (NPD), this clinical model identifies and differentiates between two phenotypic themes of dysfunction-narcissistic grandiosity and narcissistic vulnerability-that can be expressed both overtly and covertly in patients' ways of thinking, feeling, behaving, and participating in treatment. Clinical recognition that narcissistic patients can and often do present for psychotherapy in vulnerable states of depression, anxiety, shame, and even suicidality increases the likelihood of accurate diagnosis and effective treatment planning. This article provides case examples derived from psychotherapies with narcissistic patients to demonstrate how narcissistic grandiosity and narcissistic vulnerability concurrently present in patients who seek treatment.
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Some patients show a mixture of overt and covert features in different domains.
“Some patients show a mixture of overt and covert features in different domains (28).”
From Narcissistic Personality Disorder: Progress in Understanding and Treatment (2022) · cites this paper as [28]
The proliferation of alternate diagnostic labels may inform conceptualisations which do not account for the full panorama of an individual's identity, adding to the already contradictory and unintegrated self-experience for individuals with a narcissistic personality.
“However, the proliferation of alternate diagnostic labels may inform conceptualisations which do not account for the full panorama of an individual’s identity [7], adding to the already contradictory and unintegrated self-experience for individuals with a narcissistic personality.”
From Living with pathological narcissism: a qualitative study (2020) · cites this paper as [7]
The overt versus covert dimension is relatively invariable over time and across domains.
“The overt versus covert dimension is independent of the vulnerability versus grandiose dimension (11, 28), although unlike the latter, it is relatively invariable over time and across domains.”
From Narcissistic Personality Disorder: Progress in Understanding and Treatment (2022) · cites this paper as [28]
The overt versus covert dimension of pathological narcissism is independent of the vulnerability versus grandiose dimension.
“The overt versus covert dimension is independent of the vulnerability versus grandiose dimension (11, 28), although unlike the latter, it is relatively invariable over time and across domains.”
From Narcissistic Personality Disorder: Progress in Understanding and Treatment (2022) · cites this paper as [28]
Pathological narcissism (PN) is a complex, treatment-resistant disorder characterized by unstable self-esteem that fluctuates between grandiosity and vulnerability, complicating the formation of a stable self-image.
“Pathological narcissism (PN) is a complex, treatment-resistant disorder characterized by unstable self-esteem that fluctuates between grandiosity and vulnerability, complicating the formation of a stable self-image.”
From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [54]
In narcissistic personality disorder, hypersensitivity to the evaluations of others and fluctuation in self-esteem between grandiose and depleted states are associated with an increased risk of both suicidal and non-suicidal self-injury.
“In narcissistic personality disorder, there is frequently a hypersensitivity to the evaluations of others and a fluctuation in the self-esteem between grandiose and depleted states, depending on life circumstances [16, 17]; these are personality features associated with an increased risk of both suicidal and non-suicidal self-injury [18, 19].”
From Euthanasia and assisted suicide in patients with personality disorders: a review of current practice and challenges (2020) · cites this paper as [16]
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“This article provides case examples derived from psychotherapies with narcissistic patients to demonstrate how narcissistic grandiosity and narcissistic vulnerability concurrently present in patients who seek treatment.”
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Self-citation
- Authors
- Pincus, A. L., Cain, N. M., & Wright, A. G. C.
- Affiliations
- Long Island University (US)
- University of Pittsburgh (US)
- Venue
- Personality Disorders: Theory, Research, and Treatment
- Published
- 2014
- Volume
- 5
- Issue
- 4
- Pages
- 439-443
- ISSN
- 1949-2715 (ISSN-L)
- 1949-2723
- OpenAlex
- W2168503133
- Cited by
- 267
- References
- 21
- Citations by year
- 2026: 21 · 2025: 29 · 2024: 23 · 2023: 27 · 2022: 21 · 2021: 27 · 2020: 24 · 2019: 18 · 2018: 26 · 2017: 25 · 2016: 12 · 2015: 9 · 2014: 2 · 2013: 3
- FWCI
- 18.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Personality Disorders Theory Research and Treatment (publishedVersion)
- PubMed (publishedVersion)
- Rutgers University Community Repository (Rutgers University) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- narcissistic grandiosity, narcissistic vulnerability, pathological narcissism, narcissistic personality disorder, depression, anxiety, shame, suicidality, diagnosis, treatment planning
- MeSH terms
- Humans, Narcissism, Personality Disorders, Psychotherapy, Self Concept
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