Fear and decision-making in narcissistic personality disorder—a link between psychoanalysis and neuroscience
Open accessAbstract
Linking psychoanalytic studies with neuroscience has proven increasingly productive for identifying and understanding personality functioning. This article focuses on pathological narcissism and narcissistic personality disorder (NPD), with the aim of exploring two clinically relevant aspects of narcissistic functioning also recognized in psychoanalysis: fear and decision-making. Evidence from neuroscientific studies of related conditions, such as psychopathy, suggests links between affective and cognitive functioning that can influence the sense of self-agency and narcissistic self-regulation. Attention can play a crucial role in moderating fear and self-regulatory deficits, and the interaction between experience and emotion can be central for decision-making. In this review we will explore fear as a motivating factor in narcissistic personality functioning, and the impact fear may have on decision-making in people with pathological narcissism and NPD. Understanding the processes and neurological underpinnings of fear and decision-making can potentially influence both the diagnosis and treatment of NPD.
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NPD is associated with elevated fear and avoidance and a propensity to react with anger out of shame.
“It is also associated with elevated fear and avoidance (36) and a propensity to react with anger out of shame (37).”
From Narcissistic Personality Disorder: Progress in Understanding and Treatment (2022) · cites this paper as [36]
The Fear section describes fear as a motive for distancing and avoidance in NPD, including avoidance driven by fear of shame and exposure. It does not establish that fear is elevated relative to a comparison group; the paper says direct research on fear in narcissism is sparse. The anger-from-shame clause is attached to citation (37), not this source. (LLM, conf=0.84)
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Löffler‐Stastka, H., & Wong, G. (2020) · World Journal of Meta-Analysis · doi:10.13105/wjma.v8.i3.178 · Cited by 2 · see citing works
Gori, A., & Topino, E. (2025) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70179 · Cited by 1 · see citing works
Shao, X., Wang, C., Shen, C., Jia, Y., & Wang, W. (2020) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2020.84.3.278 · Cited by 1 · see citing works
Dickinson, S. (2023) · Psychoanalytic Social Work · doi:10.1080/15228878.2023.2224042 · Cited by 1 · see citing works
It’s all about resources: Narcissistic CEOs and entrepreneurial orientation during disruptions
Chugh, R., Mockaitis, A. I., Lanivich, S. E., & Nooshabadi, J. E. (2024) · International Small Business Journal Researching Entrepreneurship · doi:10.1177/02662426241269774 · Cited by 1 · see citing works
Ronningstam, E. F., & Russell, T. D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108333931.051 · Cited by 1 · see citing works
Self-citationGasparre, A., & Dimaggio, G. (2023) · QUADERNI DI PSICOTERAPIA COGNITIVA · doi:10.3280/qpc52-2023oa16174 · Cited by 1 · see citing works
Нейропсихологічні кореляти конструктів теорії особистості Карла Роджерса
Lytvyn, S., Малишева, К. О., & Морозова-Ларіна, О. І. (2017) · Scientific periodicals of Ukraine
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McMaster, A. (2021) · CUNY Academic Works (City University of New York)
The Influence of Top Executives’ Narcissism on Working Capital Management PoliciesPreprint
van Duin, S. R., Desai, H., & ElKhatib, Z. (2023) · SSRN Electronic Journal · doi:10.2139/ssrn.4463634
Dineva, S. Y. (2023) · Annals of Reviews & Research · doi:10.19080/arr.2023.10.555781
Bezerra, L. M. R., Melo, M. C. C., Bezerra, I. A. R., Carvalhal, A. M. A., de Oliveira, M. C. A., Ribeiro, Y. K. D. R., Ferreira, M. C. M., Miranda, L. A., & Botelho, A. P. B. (2024) · RECIMA21 - Revista Científica Multidisciplinar · doi:10.47820/recima21.v5i4.5105 · Cited by 1 · see citing works
The Neural Correlates of Narcissism
Ash, S., Joodi, N., & Keenan, J. P. (2024) · Springer eBooks · doi:10.1007/978-3-031-32035-4_157-1
The Neural Correlates of Narcissism
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Sacred lines and final choices: attitudes toward Physician Aid-in-Dying
Opariuc‐Dan, C., Cobzeanu, A., Postolache, I., Iftene, C., Li, X., He, H., Cobzeanu, B. M., & Tănase, I. (2026) · Ethics & Behavior · doi:10.1080/10508422.2026.2685825
Genetic Basis of Narcissistic Personality Disorder
Amjad, E., & Sokouti, B. (2026) · Springer eBooks · doi:10.1007/978-3-032-11375-7_570
- Authors
- Ronningstam, E., & Baskin-Sommers, A. R.
- Affiliations
- Harvard University (US)
- University of Wisconsin–Madison (US)
- Corresponding author
- Ronningstam, Elsa
- Venue
- Dialogues in Clinical Neuroscience
- Publisher
- Informa UK Limited
- Published
- 2013-06-30
- Volume
- 15
- Issue
- 2
- Pages
- 191-201
- ISSN
- 1294-8322 (ISSN-L)
- 1958-5969
- PMC
- PMC3811090
- OpenAlex
- W4297574313
- Cited by
- 47
- References
- 67
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 4 · 2023: 8 · 2022: 4 · 2021: 2 · 2020: 9 · 2019: 2 · 2018: 5 · 2017: 2 · 2016: 2 · 2015: 2 · 2014: 1
- FWCI
- 1.85
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Dialogues in Clinical Neuroscience (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed
- Funders
- National Institute on Drug Abuse (T32DA015036)
- 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, pathological narcissism, fear, decision-making, self-regulation, self-agency, psychopathy, attention, emotion and cognition, psychoanalysis and neuroscience
- MeSH terms
- Decision Making, Emotions, Fear, Humans, Narcissism, Neurosciences, Personality Disorders, Psychoanalysis, Self Concept
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