Narcissistic Personality Disorder: A Clinical Perspective
Abstract
Narcissistic traits and narcissistic personality disorder (NPD) present specific diagnostic challenges. While they are often readily and straightforwardly identified, their presentation in some patients and the reasons for which such patients seek treatment may conceal significant narcissistic pathology. Recently, several empirical studies have confirmed that the phenotypic range of people with NPD includes individuals with insecure, shy, and hypersensitive traits with prominent internalized narcissistic features and functioning. Other studies have confirmed that internal emotional distress, interpersonal vulnerability, fear, pain, anxiety, a sense of inadequacy, and depressivity can also co-occur with narcissistic personality functioning. This paper focuses on integrating these findings into the diagnostic evaluation and initial negotiation of treatment for NPD. In patients with narcissistic traits or NPD, it is important to give attention to the two sides of character functioning, which include both self-serving and self-enhancing manifestations as well as hypersensitivity, fluctuations in self-esteem, and internal pain and fragility. This article highlights some of these seemingly incompatible clinical presentations of narcissistic traits and NPD, especially as they co-occur with depressivity and perfectionism, and it discusses implications for building a treatment alliance with a patient with such a predominant disorder of character functioning. The article also discusses the importance of retaining the NPD diagnosis as a separate type of personality disorder, with this range of features, in the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DMS-5).
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
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 [17]
Cited by
Sorted by citations
Narcissistic Personality Disorder: Diagnostic and clinical challenges
Caligor, E., Levy, K. N., & Yeomans, F. E. (2015) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2014.14060723 · Cited by 271 · see citing works
“Regardless of severity, the grandiosity and defensiveness that characterize narcissistic personality disorder militate against acknowledging problems and vulnerabilities andmake engagement in any form of psychotherapy difficult (33).”
BackgroundAn Integrative Approach to the Assessment of Narcissism
Roche, M. J., Pincus, A. L., Lukowitsky, M. R., Ménard, K. S., & Conroy, D. E. (2013) · Journal of Personality Assessment · doi:10.1080/00223891.2013.770400 · Cited by 133 · see citing works
“…related to narcissistic vulnerability, a central aspect of pathological narcissism in contemporary clinical theory and research (Cain et al., 2008; Levy et al., 2009; Miller, Widiger, & Campbell, 2010; Pincus, 2013; Pincus & Lukowitsky, 2010; Pincus & Roche, 2011; Ronningstam, 2009, 2011a, 2011b).”
BackgroundConceptions of Narcissism and the <i>DSM-5</i> Pathological Personality Traits
Wright, A. G. C., Pincus, A. L., Thomas, K. M., Hopwood, C. J., Markon, K. E., & Krueger, R. F. (2013) · Assessment · doi:10.1177/1073191113486692 · Cited by 129 · see citing works
Fluctuations in grandiose and vulnerable narcissistic states: A momentary perspective.
Edershile, E. A., & Wright, A. G. C. (2021) · Journal of Personality and Social Psychology · doi:10.1037/pspp0000370 · Cited by 112 · see citing works
“34 4.0 Discussion Clinicians have noted that narcissistic individuals fluctuate in their expressions of grandiosity and vulnerability (e.g., Kernberg, 1975; Wright, 2014; Pincus et al., 2014; Ronningstam, 2009, 2011).”
InfluentialPathological narcissism and interpersonal behavior in daily life.
Roche, M. J., Pincus, A. L., Conroy, D. E., Hyde, A. L., & Ram, N. (2012) · Personality Disorders Theory Research and Treatment · doi:10.1037/a0030798 · Cited by 100 · see citing works
“The PNI assesses the central aspects of narcissism identified in contemporary clinical theory and research (Pincus, in press) and is designed to be consistent with how narcissism presents in clinical practice (Kealy & Rasmussen, 2012; Ronningstam, 2011).”
BackgroundPerfectionism and narcissism: A meta-analytic review
Smith, M. M., Sherry, S., Chen, S., Saklofske, D. H., Flett, G. L., & Hewitt, P. L. (2016) · Journal of Research in Personality · doi:10.1016/j.jrp.2016.07.012 · Cited by 96 · see citing works
“Indeed, as noted by Ronningstam (2011), narcissists often ‘readily announce their perfectionistic strivings and ideals, often in combination with their contempt for the perceived imperfections of other people’ (p. 93).”
BackgroundResultInfluentialNealis, L. J., Sherry, S. B., Sherry, D. L., Stewart, S. H., & Macneil, M. A. (2015) · Journal of Research in Personality · doi:10.1016/j.jrp.2015.02.006 · Cited by 66 · see citing works
“Based on previously described associations between the components of narcissistic and self-critical perfectionism in the theoretical (Ronningstam, 2011) and the empirical literatures (Hewitt & Flett, 1991), we also hypothesized that these higher-order constructs would be moderately to strongly correlated, but would be…”
BackgroundResultInfluentialFossati, A., Feeney, J., Pincus, A., Borroni, S., & Maffei, C. (2015) · Psychoanalytic Psychology · doi:10.1037/a0037175 · Cited by 64 · see citing works
Roche, M. J., Pincus, A. L., Hyde, A. L., Conroy, D. E., & Ram, N. (2013) · Journal of Research in Personality · doi:10.1016/j.jrp.2013.01.007 · Cited by 69 · see citing works
“, 2009), a self-report measure designed to assess the central aspects of narcissism identified in contemporary clinical theory and research, and to be consistent with how narcissism presents in clinical practice (Ronningstam, 2011; Wright, Lukowitsky, Pincus, & Conroy, 2010).”
BackgroundGrandiose and vulnerable narcissistic states in interpersonal situations
Edershile, E. A., & Wright, A. G. C. (2019) · Self and Identity · doi:10.1080/15298868.2019.1627241 · Cited by 58 · see citing works
“Clinical theory suggests that individuals fluctuate in their levels of grandiosity and vulnerability (Kernberg, 1975; Pincus et al., 2014; Pincus & Lukowitsky, 2010; Ronningstam, 2009, 2011; Wright, 2014).”
Modernity and narcissistic personality disorder.
Paris, J. (2012) · Personality Disorders Theory Research and Treatment · doi:10.1037/a0028580 · Cited by 56 · see citing works
“NPD patients are more likely to be divorced and/or become unemployed, often leading to depressive symptoms (Ronningstam, 2011).”
BackgroundFemale Narcissism: Assessment, Aetiology, and Behavioural Manifestations
Green, A., MacLean, R., & Charles, K. E. (2021) · Psychological Reports · doi:10.1177/00332941211027322 · Cited by 59 · see citing works
“First, to modify the current NPD criteria with explicit content covering vulnerable narcissistic features (Fossati et al., 2005; Miller et al., 2010; Pincus & Lukowitsky, 2010; Ronningstam, 2011), thereby indirectly addressing the gender issue.”
BackgroundAlliance Building and Narcissistic Personality Disorder
Ronningstam, E. F. (2012) · Journal of Clinical Psychology · doi:10.1002/jclp.21898 · Cited by 55 · see citing works
Self-citationGreen, A., & Charles, K. (2019) · Sage Open · doi:10.1177/2158244019846693 · Cited by 53 · see citing works
On the Measure and Mismeasure of Narcissism
Wright, A. G. C. (2015) · Assessment · doi:10.1177/1073191115599054 · Cited by 53 · see citing works
“One could argue against this critique given that (a) the PNI was not created to assess the narrowly defined DSMIV/DSM-5 NPD with its limited utility (Ronningstam, 2011) and (b) the PNI-Exploitativeness scale matches the expected profiles (r = .66).”
BackgroundResultDepressive tendencies and pathological narcissism among psychiatric outpatients
Kealy, D., Tsai, M. V., & Ogrodniczuk, J. S. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2011.08.023 · Cited by 50 · see citing works
“Pathological narcissism, as currently conceptualized, involves self-regulatory deficits in the forms of grandiosity and vulnerability (Pincus and Lukowitsky, 2010; Ronningstam, 2011).”
Pathological narcissism and psychosocial functioning.
Dashineau, S. C., Edershile, E. A., Simms, L. J., & Wright, A. G. C. (2019) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000347 · Cited by 43 · see citing works
Social Factors in the Personality Disorders
Paris, J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108867542 · Cited by 43 · see citing works
Kealy, D., Ogrodniczuk, J. S., Rice, S., & Oliffe, J. L. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.06.009 · Cited by 43 · see citing works
“…and vulnerability subscales being highly correlated in the present sample, r = 0.69, p<0.001, and in accordance with conceptual accounts of typically intertwined grandiosity and vulnerability (Caligor et al., 2015; Kealy and Rasmussen, 2012; Ronningstam, 2011), the total pathological 157”
BackgroundResultInfluentialMehlum, L., Schmahl, C., Berens, A., Doering, S., Hutsebaut, J., Kaera, A., Kramer, U., Moran, P. A., Renneberg, B., Ribaudi, J. S., et al. (2020) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-020-00131-9 · Cited by 42 · see citing works
A concise guide to personality disorders.
Paris, J. (2015) · American Psychological Association eBooks · doi:10.1037/14642-000 · Cited by 42 · see citing works
Narcissistic Interpersonal Problems in Clinical Practice
Kealy, D., & Ogrodniczuk, J. S. (2011) · Harvard Review of Psychiatry · doi:10.3109/10673229.2011.632604 · Cited by 41 · see citing works
Perfectionism, Shame, and Aggression in Depressive Patients With Narcissistic Personality Disorder
Fjermestad‐Noll, J., Ronningstam, E. F., Bach, B., Rosenbaum, B., & Simonsen, E. H. (2020) · Journal of Personality Disorders · doi:10.1521/pedi.2020.34.supp.25 · Cited by 44 · see citing works
“…in the following way: Perfectionism was found to be a more prominent trait in depressed patients with NPD, as both self-oriented and socially prescribed perfectionism were significantly more elevated in this group, which is in line with earlier theories (Dimaggio & Attina, 2012; Ronningstam, 2011).”
BackgroundResultInfluentialSelf-citationNeufeld, D. C., & Johnson, E. A. (2015) · Journal of Personality · doi:10.1111/jopy.12192 · Cited by 36 · see citing works
“These phenotypes share an underlying exaggerated sense of self-importance and entitlement (Dickinson & Pincus, 2003; Russ, Shedler, Bradley, & Westen, 2008) as well as impaired self-esteem regulation (Ronningstam, 2011).”
BackgroundJakšić, N., Marčinko, D., Hanžek, M. S., Rebernjak, B., & Ogrodniczuk, J. S. (2017) · Journal of Clinical Psychology · doi:10.1002/jclp.22472 · Cited by 36 · see citing works
“Current theoretical conceptualizations of pathological narcissism view shame as a major component of narcissistic vulnerability (Horowitz, 2009; Kernberg, 2009; Ronningstam, 2011), such that these persons are prone to avoiding or reducing explicit feelings of shame by using different intra- and interpersonal strategie…”
BackgroundInfluentialTanzilli, A., & Gualco, I. (2020) · Journal of Personality Disorders · doi:10.1521/pedi.2020.34.supp.42 · Cited by 36 · see citing works
Hascalovitz, A., & Obhi, S. S. (2015) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2015.00013 · Cited by 29 · see citing works
“This process has been associated with threatening swings in self-esteem, which further contribute to the fragility of the narcissistic mindset (Ronningstam, 2011a; for more on manifestation of clinical narcissism see Dimaggio et al., 2006, 2008).”
BackgroundNealis, L. J., Sherry, S., Lee‐Baggley, D., Stewart, S. H., & Macneil, M. A. (2016) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-016-9537-y · Cited by 29 · see citing works
“Narcissistic perfectionism is often discussed in theory (e.g., Ellis 1997; Ronningstam 2011), but empirical tests remain scarce.”
BackgroundVulnerable narcissism is associated with severity of depressive symptoms in dysthymic patients
Erkoreka, L., & Navarro, B. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.07.061 · Cited by 29 · see citing works
Krusemark, E. A., Lee, C. W., & Newman, J. P. (2014) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000087 · Cited by 23 · see citing works
Narcissistic personality disorder
Ronningstam, E. F. (2011) · Personality and Mental Health · doi:10.1002/pmh.172 · Cited by 21 · see citing works
Self-citationBorroni, S., Bortolla, R., Lombardi, L. M. G., Somma, A., Maffei, C., & Fossati, A. (2016) · Personality and Mental Health · doi:10.1002/pmh.1328 · Cited by 20 · see citing works
Narcissistic personality disorder and pathological narcissism
Bliton, C. F., Halberstadt, A. L., Asan, A. E., & Pincus, A. L. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-91497-0.00238-1 · Cited by 18 · see citing works
Abdelrahman, R. M., Ahmed, M., Tayim, N., & Kordbagheri, M. (2024) · Psychiatric Quarterly · doi:10.1007/s11126-024-10082-x · Cited by 17 · see citing works
“In contrast, females may demonstrate higher centrality in characteristics associated with internalized self-absorption and interpersonal frustration, such as being self-absorbed in personal pursuits (HSNS.8) and feeling privately annoyed by others’ needs (HSNS.10) [ 33, 50 ].”
Debates on the Narcissism Conundrum
Alarcón, R. D., & Sarabia, S. (2011) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e31823e6795 · Cited by 16 · see citing works
Pathological Narcissism and the Obstruction of Love
Kealy, D., & Ogrodniczuk, J. S. (2014) · Psychodynamic Psychiatry · doi:10.1521/pdps.2014.42.1.101 · Cited by 16 · see citing works
“Although this often involves maladaptive efforts at self-enhancement—such as inflated views of the self and devalued views of others—the key issue is a deficiency in healthy self-regulation (Ronningstam, 2011).”
BackgroundProcesses of Change in Psychotherapy for Narcissistic Personality Disorder
Maillard, P., Berthoud, L., Kolly, S., Sachse, R., & Kramer, U. (2020) · Journal of Personality Disorders · doi:10.1521/pedi.2020.34.supp.63 · Cited by 15 · see citing works
“…pathological narcissism or NPD can exhibit arrogant and domineering attitudes, attention seeking, need for admiration, fluctuation in empathic ability, sense of specialness, or perfectionism and high standards (Caligor, Levy, & Yeomans, 2015; Pincus & Lukowitsky, 2009; Ronningstam, 2010, 2011).”
BackgroundDay, N. J. S., Townsend, M. L., & Grenyer, B. F. S. (2022) · BMC Psychiatry · doi:10.1186/s12888-021-03660-x · Cited by 14 · see citing works
“In this way, individuals with pathological narcissism struggle with healthy self-regulation and positive selfregard [67], as the inflated and grandiose self is fragile,”
BackgroundInpatient Therapeutic Assessment With Narcissistic Personality Disorder
Hinrichs, J. (2015) · Journal of Personality Assessment · doi:10.1080/00223891.2015.1075997 · Cited by 13 · see citing works
Cain, N. M., Jowers, C. E., Blanchard, M. P., Nelson, S. M., & Huprich, S. K. (2021) · Psychopathology · doi:10.1159/000510475 · Cited by 13 · see citing works
Aplin-Houtz, M. J., Leahy, S., Willey, S., Lane, E. K., Sharma, S., & Meriac, J. P. (2023) · Employee Responsibilities and Rights Journal · doi:10.1007/s10672-023-09453-6 · Cited by 14 · see citing works
Brioschi, S., Franchini, L., Fregna, L., Borroni, S., Franzoni, C., Fossati, A., & Colombo, C. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.112575 · Cited by 11 · see citing works
Kealy, D., Woolgar, S. R., Hewitt, J. M. A., & Cox, D. W. (2022) · Current Psychology · doi:10.1007/s12144-022-02976-5 · Cited by 13 · see citing works
“Moreover, individuals high in pathological narcissism often experience both grandiosity and vulnerability (Caligor et al., 2015; Ronningstam, 2011).”
BackgroundMarčinko, D., Jakšić, N., Rudan, D., Bjedov, S., Rebernjak, B., Skopljak, K., & Bilić, V. (2020) · Psychiatria Danubina · doi:10.24869/psyd.2020.395 · Cited by 11 · see citing works
“…arrogance and an overvalued, entitled selfimage with exploitative and exhibitionistic behaviors, whereas narcissistic vulnerability refers to frail selfimage and is reflected in experiences of anger, envy, shame, and avoidance of interpersonal relationships (Pincus & Roche 2011; Ronningstam 2011).”
BackgroundPsychopathology and personality functioning
Ringwald, W. R., Woods, W. C., Edershile, E. A., Sharpe, B. M., & Wright, A. G. C. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-813995-0.00011-x · Cited by 10 · see citing works
Fjermestad‐Noll, J., Ronningstam, E. F., Bach, B., Storebø, O. J., Rosenbaum, B., & Simonsen, E. H. (2019) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-019-09437-4 · Cited by 10 · see citing works
“Furthermore, in these patients, psychological factors such as, shame, perfectionism and aggression are often observed, and are thought to complicate the treatment process (Ronningstam 2011, 2012).”
BackgroundInfluentialSelf-citationBlay, M., Duarte, M., Benmakhlouf, I., Amate, M., Perroud, N. A., Speranza, M., Choi-Kain, L. W., & Ronningstam, E. F. (2024) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000797 · Cited by 9 · see citing works
Self-citationStanton, K. J., Watson, D., & Clark, L. A. (2017) · Personality and Mental Health · doi:10.1002/pmh.1404 · Cited by 9 · see citing works
Day, N. J. S., Green, A., Denmeade, G., Bach, B., & Grenyer, B. F. S. (2024) · Journal of Clinical Psychology · doi:10.1002/jclp.23701 · Cited by 13 · see citing works
Neshat, Z., Bijari, A. F., & Dehshiri, G. (2023) · Cognitive Processing · doi:10.1007/s10339-023-01163-z · Cited by 8 · see citing works
“Narcissistic perfectionists face challenges in daily social relationships (Nealis et al. 2015) since they seek approval and respect from others in their relationships (Ronningstam 2011).”
Case Conceptualization in Clarification-Oriented Psychotherapy
Sachse, R. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-813521-1.00007-2 · Cited by 8 · see citing works
Haider, A., Mehmood, A., & Zhang, W. (2024) · Current Psychology · doi:10.1007/s12144-024-07118-7 · Cited by 7 · see citing works
“It is noteworthy that narcissism and perfectionism share similar characteristics in behaviors, linking, and noting (Ronningstam, 2011 ).”
Jahani, H. J. G., Ehsanikenari, A., & Sharif, A. S. (2018) · Emerging Science Journal · doi:10.28991/esj-2018-01158 · Cited by 7 · see citing works
“1- Introduction In clinical context, narcissism is characterized by such traits as grandiosity, mental involvement with fantasies of unlimited success, power, talent, and beauty, belief in being an outstanding and special person [1, 2], sense of omnipotence, tendency toward colonialism in inter-personal relationships,…”
BackgroundKlerks, M., Dumitrescu, R., & Caluwé, E. D. (2024) · Acta Psychologica · doi:10.1016/j.actpsy.2024.104499 · Cited by 6 · see citing works
Smith, M. M., Sherry, S., & Saklofske, D. H. (2018) · Springer eBooks · doi:10.1007/978-3-319-92171-6_28 · Cited by 6 · see citing works
Huprich, S. K. (2020) · Journal of Personality Disorders · doi:10.1521/pedi.2020.34.supp.207 · Cited by 6 · see citing works
Narcissistic Personality Disorder
Ronningstam, E. F. (2015) · Elsevier eBooks · doi:10.1016/b978-0-12-397045-9.00089-6 · Cited by 6 · see citing works
Self-citationCriminel en col blanc de grande envergure. Un renard bien cravaté
Ouimet, G. (2011) · Psychologie Française · doi:10.1016/j.psfr.2011.10.003 · Cited by 5 · see citing works
Narcissism and its discontents.
Wright, A. G. C. (2014) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000007 · Cited by 5 · see citing works
“Clinically, these individuals often report substantial symptomatic distress (see Ronningstam, 2011), including, but not limited to, difficulties with emotional regulation, intense shame associated with their entitled expectations, significant interpersonal discord, social withdrawal, depressed…”
Interpersonal Functioning of Narcissistic Individuals and Implications for Treatment Engagement
Lamkin, J. (2018) · Springer eBooks · doi:10.1007/978-3-319-92171-6_50 · Cited by 5 · see citing works
Exploring the Phenomenon of Mass Murder in Public Places
Kerr, S. E. M., & Markey, M. A. (2019) · IGI Global eBooks · doi:10.4018/978-1-7998-0113-9.ch008 · Cited by 5 · see citing works
Pathological Narcissism: A Front-Line Guide
Kealy, D., & Ogrodniczuk, J. S. (2012) · Practice · doi:10.1080/09503153.2012.679255 · Cited by 5 · see citing works
“Recent reviews have addressed pathological narcissism from the perspectives of psychiatric pathology and diagnosis (Ronningstam 2011a), construct refinement and assessment (Pincus and Lukowitsky 2010), personality psychology research (Bosson et al. 2008) and psychodynamic psychotherapy within…”
BackgroundInfluentialMuscle Dysmorphia in Gym-Going Men: The Role of Narcissism Vulnerability and Perfectionism.
Kandemir, H., Cipriano, A., Rosato, M. S., Ünsalver, B. Ö., Stabile, M., & Cella, S. (2024) · PubMed Central · doi:10.36131/cnfioritieditore20240303 · Cited by 4 · see citing works
“…and research agree in considering perfectionism to be particularly problematic in narcissism, as perfectionistic traits may serve to hide an imperfect and vulnerable self in an attempt to protect and enhance individual self-image (Morf & Rhodewalt, 2001; Pincus et al., 2014; Ronningstam, 2011).”
BackgroundMalone, B. C., & Huprich, S. K. (2023) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001646 · Cited by 3 · see citing works
“…as subtypes of pathological narcissism, they argue that one should view the pathological narcissist as one who excessively oscillates between transient grandiose and vulnerable “positions” or self-states as ameans to stabilize conflictual feelings regarding self-esteem (Ronningstam, 2011).”
BackgroundPedone, R., Huprich, S. K., Colle, L., Barbarulo, A. M., & Semerari, A. (2023) · Journal of Personality Disorders · doi:10.1521/pedi.2023.37.3.285 · Cited by 3 · see citing works
Dark Triad Caregivers and Their Children
Lau, K. S. L., Le, J. U., & Martins, K. F. (2024) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-024-10174-9 · Cited by 3 · see citing works
“Such interventions may include cognitive restructuring techniques or dialectical behavioral therapy (Linehan, 1993; Ronningstam, 2011).”
THE RELATIONSHIP BETWEEN EMOTIONAL INTELLIGENCE AND PERSONALITY DISORDER SYMPTOMATOLOGY
Martskvishvili, K., & Mestvirishvili, M. (2014) · Problems of Psychology in the 21st Century · doi:10.33225/ppc/14.08.143 · Cited by 3 · see citing works
“…or aggressive, and manipulative, effectively hide or openly exhibit the most extreme narcissistic tendencies, but the underlying commonality for all of them is that they all struggle with grandiosity, are assertive, behave dominantly and expressively and arrogant (Ronningstam, 2009, 2011).”
BackgroundPersonality Organization and Depressive Symptoms Among Psychiatric Outpatients
Jakšić, N., Marčinko, D., Bjedov, S., Mustač, F., & Bilić, V. (2022) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001494 · Cited by 3 · see citing works
“For example, individuals with lower PO level exhibiting narcissistic pathology are particularly prone to explicit and implicit shameful experiences (Ritter et al., 2014; Ronningstam, 2011), which in turn seem to promote their increased risk of suicidal tendencies (Jaksic et al., 2017).”
BackgroundNarcissistic biographies third age self‐transcendence abilities. Commentary
Fjermestad‐Noll, J., & Rosenbaum, B. (2014) · Personality and Mental Health · doi:10.1002/pmh.1254 · Cited by 2 · see citing works
Quasi-psychosis in covert Narcissistic Personality Disorder—A case report
Subramanian, K., Selvakumar, N., Karunanithi, A., Rajan, T. M., Kandasamy, P., & Kattimani, S. (2017) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2017.12.009 · Cited by 2 · see citing works
Kállay, É., & Mihoc, A. R. (2021) · Studia Universitatis Babeș-Bolyai Psychologia-Paedagogia · doi:10.24193/subbpsyped.2021.1.01 · Cited by 2 · see citing works
“Furthermore, literature also indicates that perfectionism is a central feature of narcissism (Ronningstam, 2010, 2011), and is a strong predictor of depression (Hewitt, Flett, & Ediger, 1996).”
BackgroundFox, C. (2019) · Springer eBooks · doi:10.1007/978-3-030-19194-8_10 · Cited by 2 · see citing works
The associations between grandiose narcissism and perfectionism: New insights into an old debate
Vecchione, M., Vacca, M., Dentale, F., Lombardo, C., Geukes, K., & Back, M. D. (2023) · Personality and Individual Differences · doi:10.1016/j.paid.2023.112395 · Cited by 2 · see citing works
Tracing the Link Between Narcissistic Personality Disorder and Childhood Overgratification
Thalib, H. I., Zobairi, A., Khan, S., Touk, M. A., Bahkali, R. I., Alhusaynan, S., & Hussain, S. F. (2024) · Cureus · doi:10.7759/cureus.72638 · Cited by 1 · see citing works
“He’s a Full-Blown Narcissist:” Tracing an Emerging Cultural Narrative in Action
Sweet, P. L., & Cooper, C. E. (2025) · Social Problems · doi:10.1093/socpro/spaf009 · Cited by 1 · see citing works
Manifestations of vulnerability in narcissistic personality disorder: a review
Pledger, D., Hardaker, M., & Tsakanikos, E. (2025) · Academia Mental Health and Well-Being · doi:10.20935/mhealthwellb7718 · Cited by 1 · see citing works
Cherrier, J.-F. (2013) · Santé mentale au Québec · doi:10.7202/1019195ar · Cited by 1 · see citing works
Paris, J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108867542.004 · Cited by 1 · see citing works
Kealy, D. (2015) · cIRcle (University of British Columbia) · doi:10.14288/1.0166111
“The key issue is a relative deficiency in healthy self-regulation (Kealy & Rasmussen, 2012; Ronningstam, 2011a).”
BackgroundPersonality Disorders as a Psychiatric Emergency
Bielska, W., & Copeland, G. (2016) · doi:10.1093/med/9780190250843.003.0009
Social Factors in the Personality Disorders : Finding a Niche
Paris, J. (2020)
Kállay, É. (2020) · Studia Universitatis Babeș-Bolyai Psychologia-Paedagogia · doi:10.24193/subbpsyped.2020.2.02
Motivations Underlying Mass Acts of Violence
Barone, P. A. (2021) · Advances in psychology, mental health, and behavioral studies (APMHBS) book series · doi:10.4018/978-1-7998-4957-5.ch001
Paris, J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108867542.009
Antisocial Personality Disorder
Paris, J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108867542.010
Paris, J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108867542.013
Modernity and Personality Disorder
Paris, J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108867542.007
Paris, J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108867542.001
Paris, J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108867542.002
Paris, J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108867542.003
A Biopsychosocial Model of Personality Disorders
Paris, J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108867542.012
Social Context and Personality
Paris, J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108867542.006
Paris, J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108867542.008
Paris, J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108867542.011
Personality Traits and Personality Disorders
Paris, J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108867542.005
Narzisstische Persönlichkeitsstörungen
Sachse, R. (2020) · Springer eBooks · doi:10.1007/978-3-662-45995-9_42-1
Paris, J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108867542.014
Zeigler‐Hill, V., & Jordan, C. (2013) · doi:10.1093/obo/9780199828340-0113
Motivations Underlying Mass Acts of Violence
Barone, P. A. (2022) · IGI Global eBooks · doi:10.4018/978-1-6684-7464-8.ch001
Séguin, D., & Descôteaux, J. (2023) · SSRN Electronic Journal · doi:10.2139/ssrn.4496504
- Authors
- Ronningstam, E.
- Affiliations
- Harvard University (US)
- Corresponding author
- Ronningstam, Elsa
- ORCID
- Ronningstam, Elsa
- Venue
- Journal of Psychiatric Practice
- Published
- 2011-03
- Volume
- 17
- Issue
- 2
- Pages
- 89-99
- ISSN
- 1527-4160 (ISSN-L)
- 1538-1145
- OpenAlex
- W2015531628
- Cited by
- 111
- References
- 0
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 11 · 2023: 7 · 2022: 4 · 2021: 5 · 2020: 25 · 2019: 8 · 2018: 3 · 2017: 5 · 2016: 4 · 2015: 9 · 2014: 7 · 2013: 5 · 2012: 5
- FWCI
- 7.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychiatric Practice (publishedVersion)
- PubMed (publishedVersion)
- 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 personality disorder, narcissistic personality traits, diagnostic assessment, treatment alliance, perfectionism, hypersensitivity, DSM-5, personality disorder diagnosis
- MeSH terms
- Adult, Depression, Female, Humans, Male, Middle Aged, Narcissism, Personality Disorders, Self Concept, Comorbidity, Diagnostic and Statistical Manual of Mental Disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
