The DOI matches its Crossref record; 21 of the 21 references it cites were found in a registry or an index.
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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In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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 the citing paper
“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]
Citations
Cites
Diagnostic and Statistical Manual of Mental Disorders, 5th ed.
Carter, M. J. (2014) · Therapeutic Recreation Journal · Cited by 15,154
Pathological narcissism and narcissistic personality disorder
Pincus, A. L., & Lukowitsky, M. R. (2010) · Annual Review of Clinical Psychology · doi:10.1146/annurev.clinpsy.121208.131215 · Cited by 1,082
Self-citationCain, N. M., Pincus, A. L., & Ansell, E. B. (2008) · Clinical Psychology Review · doi:10.1016/j.cpr.2007.09.006 · Cited by 876
Self-citationRefining the Construct of Narcissistic Personality Disorder: Diagnostic Criteria and Subtypes
Russ, E., Shedler, J., Bradley, R., & Westen, D. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2008.07030376 · Cited by 272
The Higher Order Factor Structure and Gender Invariance of the Pathological Narcissism Inventory
Wright, A. G. C., Lukowitsky, M. R., Pincus, A. L., & Conroy, D. E. (2010) · Assessment · doi:10.1177/1073191110373227 · Cited by 271
Self-citationNarcissistic personality disorder and the DSM-V.
Miller, J. D., Widiger, T. A., & Campbell, W. K. (2010) · Journal of Abnormal Psychology · doi:10.1037/a0019529 · Cited by 244
Narcissistic Personality Disorder: Facing DSM-V
Ronningstam, E. (2009) · Psychiatric Annals · doi:10.3928/00485713-20090301-09 · Cited by 226 · cited 2×
“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.”
BackgroundNarcissistic Grandiosity and Narcissistic Vulnerability
Pincus, A. L., & Roche, M. J. (2011) · The Handbook of Narcissism and Narcissistic Personality Disorder · doi:10.1002/9781118093108.ch4 · Cited by 217
Self-citationGrandiose and Vulnerable Narcissism and the DSM–5 Pathological Personality Trait Model
Miller, J. D., Gentile, B., Wilson, L., & Campbell, W. K. (2013) · Journal of Personality Assessment · doi:10.1080/00223891.2012.685907 · Cited by 145
Ellison, W. D., Levy, K. N., Cain, N. M., Ansell, E. B., & Pincus, A. L. (2013) · Journal of Personality Assessment · doi:10.1080/00223891.2012.742904 · Cited by 137
Self-citation
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Braun, S. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.00773 · Cited by 229
Orth, U., Robins, R. W., Meier, L. L., & Conger, R. D. (2016) · Journal of Personality and Social Psychology · doi:10.1037/pspp0000038 · Cited by 214
Interpersonal Dynamics in Personality and Personality Disorders
Hopwood, C. J. (2018) · European Journal of Personality · doi:10.1002/per.2155 · Cited by 239
Development of a brief version of the Pathological Narcissism Inventory.
Schoenleber, M. L., Roche, M. J., Wetzel, E., Pincus, A. L., & Roberts, B. W. (2015) · Psychological Assessment · doi:10.1037/pas0000158 · Cited by 219
Self-citationTrait entitlement: A cognitive-personality source of vulnerability to psychological distress.
Grubbs, J. B., & Exline, J. J. (2016) · Psychological Bulletin · doi:10.1037/bul0000063 · Cited by 180
Metadata
- 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
- 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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